310770_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: _,Olioutine O Complaint O Follow-up Q Referral Q Emergency O Other Q Denied Access
Y�YYYYYY� •r-
r
Date of Visit: I I ►'ytJ(1 1I
Arrival Time:
Departure Time: County:
Farm Name:
Q
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Nam, i
Certified Operator: /�} o 40
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Region:
Certification Number: 2 6 0 q g-
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
Wet Poultry
Layer
Design
C•apaeity
Current
Pop.
Cattle
Dairy Cow
Design Current
C►apacity Pup.
Wean to Feeder
I INon-Layer
I
Dairy Calf
eeder to Finish
"7
Daig Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oul_ f
Layers
Design
Ca ac[
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turlce s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ [/] Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes,,ET]No
❑ Yes �No
❑NA ❑NE
❑ NA ❑ NE
❑ NA 0 NE
Page l of 3 21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is Storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
�
❑ Yes o `"o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �Vo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ,ETNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes •E5*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
❑ Yes­4ET'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yesj;�'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Z'f o
❑ 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 JJ<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes,,[D'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yesiff No
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ,12'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes _12'1Go
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below.
❑ Yeses <o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ET'T�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes —E]I o
❑ NA
❑ NE
Page 2 of 3
21412015 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 ❑ Yes _12-Wo ❑ 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�❑'r4o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes_�Wo
❑ 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 Ej'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 F,;'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 ;D No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ,E5ON'o
❑ NA ❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes � - ' V
❑ NA ❑ NE
Comments. (refer to questions 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:
Reviewer/Inspector Signature:
Page 3 of 3
lyl•--�� Iv �i a Phone: 90-7 — / 3L
Date: !iL!
2/4/20I5

r
.t
Type of Visit: O Zvoutine
pliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3, Arrival Time: ® Departure Time: f County: - Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: JOL gq:MyqI's iLl j Integrator:
Certified Operator: Certification Number: 2�((7 a"
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish 6
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
13 r P,o .Itr, C•_a aci P,o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
E2
❑ 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
❑ Ng
❑ 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 21412015 Continued

Facili Number: Date of Inspection: Iff
F Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA
&Z/No ❑ NA ❑ NE
❑ No ❑ NA [] NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ 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 environmen I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 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 [yNo
❑ 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 No
❑ 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
dNo
[DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
gNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facie Number: - Date of Inspection: 0#jjajJ6
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 2f No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [//No ❑ NA ❑ NE
❑ Yes do ❑ NA ❑ NE
❑Yes �o ❑NA ❑NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
[j ❑NA ❑NE
❑NA ❑NE
No ❑ NA ❑ NE
Comments(refer to. question #.):„Explain anyNES answers and/or_any additional recommendations_or any other comments.
Use drawings of facility to better explain situation
s (use additional pages as necessary). .
0 L/C 76 WAS IV RAJ-�4FAb(.
qII/((, <7q 112Otar^'
I�, ao bay �M-
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
O/M
Date: 91'�2 / I U
5

Type of Visit: (3 rRoutine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 7 Arrival Time: Departure Time: County: 1 P( Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative:y��Afi�� / ill _u&g- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: d� V
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I I Layer
I
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Design
C+urrent
Da' Heifer
Cow
Farrow to Feeder
D . P,ouih:
Ca aei
P,o ,
Non -Dairy
Farrow to Finish I
GiltsI
ILayers
INon-Layers
I
Beef Stocker
Beef Feeder
BoarsI
JPullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Outer
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ 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 1 of 3 21412014 Continued

FaciIi Number: -;7 7 Date of lns ection: 4 1 1-111
Waste Collection & Treatment
4- [s 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
StructureStructure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _--1—�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[]Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
40
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
EJ/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 �3No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z j o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
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
YNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CdNo ❑ 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 I �J 1� ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes II 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 YNo
d�o ❑ NA ❑ NE
25. -Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 GAWMP?
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?
Reviewer/Inspector Signatur
Page 3 of 3
❑ Yes �o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes WNo ❑ NA ❑ NE
❑ Yes EJ/No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
F�o ❑ NA ❑ NE
o ❑ NA ❑ NE
No ❑ NA ❑ NE
"1 1
/is-
214.12015

Type of Visit: Q C pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 ��f)
Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: :Dyp ciRegion:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Desigu Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Da Cow
Da' Calf
DairyHeifer
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
1D . P�oult r Ca aci_ P,a ,
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turke s
Turkey Pouets
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 No ❑ NA ❑ NE
[:]Yes [—]No
[:]Yes ❑ No
(DNA ❑ NE
❑ NA ❑ NE
[:]Yes FNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

r$cility Number: ) Date of Inspection: f
Waste Collection & Treatment
4 Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
E St��j
trl Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA
Spillway?:
WNo ❑ NA ONE
[:]No ❑ NA ❑ NE
Structure 6
Designed Freeboard (in): 22
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes h10 ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Zo
[3 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 PO ❑ 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 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 ZNio ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,/ No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �To ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[:]Yes �
❑ Yes �o
❑ Yes �`Nq
Yes No
❑ 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 Inspecti��NOV
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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FF ility Number: jDate of Inspection: Cf
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes �N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes VN0o
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality 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 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:)Yes /No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers andlor any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additionalpages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: M
Date:
11
Page 3 of 3 / 2141201

Type of Visit: O Co pliance Inspection V Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: 1///) County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: >JON
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: 6
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I Ell
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dz, P,o_ultr. Ca aci. P.
I Layers
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Turkey Poults
Other
Other
Other
Discharges and Stream Imoacts
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 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�N
❑ 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

FaciliNumber: 7- Date of Inspection:
*aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes [Z/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes [:]No ❑ NA ❑ NE
Stn}cture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t,//A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[_] ❑ 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 CNo ❑ 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 l�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 21 XO ❑ 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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I,d'1 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[• -
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[,311qo'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes �10
❑ 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.
0 Yes EJ4<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections P Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
-14. Did the facility fail to calibrate waste application equipment as required by the permit? F ❑ Yes 04 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ; _ Y ❑ 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 <NoIC] 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
❑ 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 �"" ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
(D'�/o
❑ NA ❑ NE
[2 No ❑ NA 0 NE
No ❑ NA ❑ NE
(Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facilitv to better exulain situations (use additional naves as necessarv).
Reviewer/Inspector Name: t .,bA#,J _ 4 Phone:
'?3
Reviewer/Inspector Signature: i_4d ,,, , //Wc4&j/j Date:
Page 3 of 3 ! 121412011

W-4
Type of Visit: (y7Routine
fiance 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: C6 y Arrival Time: = Departure Time: County: �y ~' Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �Tiit+l�e:
Onsite Representative: ION gal Q& 1 1 r +-�--L'L&'
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
integrator:
Certification Number: 0?60 !.2..
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
We# Poultry Capacity Pap.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
5
Design Current
Di, P■oul, Ca .act P,o
Layers
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
,Turkey Poults
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)
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 [3NA ❑ NE
❑ Yes �zo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3
214120II Continued

Facility Number; - rilo IDate of Inspection: f D •t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 � Structure 2
j`�� ;)
Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes O/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental rest, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ej N ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ErNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
EfN
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
1V o
❑ NA
❑ NE
[:]Yes
No ❑ NA ❑ NE
❑ Yes IVo ❑ NA ❑ NE
❑ Yes ICJZ
❑ NA [] NE
❑ Yes ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q 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 �o NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number; I - 7n Date of Inspection: Dga
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 KNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes gl<o ❑ 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 Dee ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes 24'o ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ffNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E�<
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Comments (refer to question #): Explain any YES answers and/or any additional recommendationsvr, any other
Use` drawines of facility to better explain situations (use additional naves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: / — �O
Date: 104
214,4011

R
Type of Visit: Q CoWpliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a q Arrival Time: [! V Departure Time: © County: D14,rl+l Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: J01I1iiia1v 61M'L&7_ Integrator:
Certified Operator: Certification Number: 07%
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current Design Current
Design Current
Swine Capacity .Pop. Wet Poultry C►apacity Pop.
Cattle
Capacity Pop.
Wean to Finish La er
Dai Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish i7 Sam
Da' Heifer
Farrow to Wean Design Current
Dry Cow
Farrow to Feeder D . P,oul , Ca aci P,o ,
Non -Dairy
Farrow to Finish I Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Dischartres 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 LJ No NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA C] NE
[—]Yes ❑ NA ❑ NE
❑ Yes jeNg
❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: 3 - FDate o
L
Waste Collection & Treatment
4. Js 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: LA>XV%%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Jay
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes M/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [—]Yes Elio D NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes 1:240 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes P/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 [ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:)Yes [3"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [211�o ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E�Xo ❑ NA ❑ NE
[:]Yes C)Ao ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes QrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�<o ❑ NA ❑ NE
the appropriate box.
❑Wi1P ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes , o ❑ NA ❑ NE
Page 2 of 3 2/4/2011 Continued

FaciliNumber: - Date of Inspection:
4
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ej o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�o
❑ NA ❑ NE
the appropriate box(cs) 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
[ 11go
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[D No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[fNo ❑ 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
L2fi7o ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
/
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Ej<o ❑ 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
Q N ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
II 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:
1010 N.1 rOaL
Phone: l V
Reviewer/Inspector Signature:
Page 3 of 3
Date: I / q
21412011

Drvision of:Water Qua O'bivision "of
Faclltty Number 7 __J0 Other Agencyd and Water Conservation �.
-,
Type of Visit Co pi lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: DUP U/r1 1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
3
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c = ❑ « Longitude: = ° 0 0
Desrg'oCurrenf:-Desigp fi Current �� , Designs Current-
Capacity 'Population :Wet Poultry Capacity Population:- CattleCapacity,Populatiori
❑ Wean to Finish
i
❑ Wean to Feeder
_
Feeder to Finish
6b
16
"' ❑ Farrow to Wean
'' ❑ Farrow to Feeder
0 ❑ Farrow to Finish
❑ Gilts
" ❑ Boars
❑ Layer
❑ Non -Layer
J_jrv`Piiultrv" n, .. k
Pullets
1er ,t . ❑ Turkey Poults
Other Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 CZ/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑
❑ Yes
LYJ o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

i
Facility Number: S —'�'�6 Date of Inspection 1d IL
:
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 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LAe--+J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes L'J No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [�No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes d 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 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ N , ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
" ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
:Comments•(refer toagnestion,#): , Explainany�,YES.answers and/or any recommendations or any,,other coma
;Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Ins ector Name
p
W
Phone
_
Reviewer/Inspector Signature:
Date: 1 0 ,110
Page 2 of 3 If 12128104 Continued

lj�ciiity Number: 11d Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other _
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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
❑ Yes LINO ❑ NA ❑ NE
❑ Yes I No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes O No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�hio
[INA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
VNo
❑ NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
❑ NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CTNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
td'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
B 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
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
CKO
❑ NA
❑ NE
Additional Comments and/or Drawings;
Page 3 of 3 12128104

31 H 910
Type of Visitpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
4outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 3�'uP UW Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Mat-L- *_ Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' 0 « Longitude: = ° = 1 = «
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
n-La er
❑ Dai Calf
® Feeder to Finish S'76o
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
El Layers
❑ Beef Stocker
Gilts
ElNon-Layers
[IBeef Feeder
Po Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & Stream Imuacts
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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El No
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
iJ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:31— io Date of Inspection"TZ !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier: L Ct-nr.J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 v ^
Structure 4
❑ Yes Ej`No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [I 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? Cl Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes I[J No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes 2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dlNo ❑ 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 t0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
zI,
❑NA
❑ NA
0 ❑ NA
❑ NA
No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/inspector Name j &N t-j 4a/")j Phone: &,' /7G —1 W
Reviewer/inspector Signature: Date: y 5
Page 2 of 3 12128104 Continued

Facility Number• r=
•3 —1"i0 Date of Inspection
�to wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
Cl Yes
[3'No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
El�J
,dNN
El NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,L_,/No
L( No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[_No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ej`No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
El Yes
, ��
�ZNo
❑ NA
❑ NA
❑ NE
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
FfNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,. ,/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
N
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
12128104

7-1a
Type of Visit Co Hance Inspection Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit Routine O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: `i O Arrival Time: IJ3 Departure Time: County: {,�1A7 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: `j�NrAT Nr��YL- Integrator:
Certified Operator: Operator Certification Number:
Sack -up Operator: Sack -up Certification Number:
Location of Farm: Latitude: e = I = Longitude: = ° = 1
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer j
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
O#her
❑ Other
Q]Turkey Poults
❑ Other
Number of Structures: E]
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes UrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
El Yes
❑ KA
❑ Yes
C No NA
❑ NE
❑ Yes
❑ o
ElNA
❑ NE
12128104
Continued

FacWtyNumber: 3 -�%� Date of Inspection i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes (3 NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
7No
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ 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 tthhr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Zo
❑NA ❑ NE
8. Do any of the stuctures 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes d /No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9<0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
determination?❑
El Yes
,[�]'No
L T
ElNA
[INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre Yes
[I NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El
F
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
ElYes
El
❑ NA
❑ NE
Comments {refer tolqueshon. # Explai! a Y sw�er.0iii / s�r o nmendatio-Mo , ny other, comments.
Use drawmgs.ofhfacilrty'to better explam sttuahoii (use additional:pages>as.necessary):
..,e�
f �
Reviewer/Inspector Name _ T 6A %J ���Q/U� ((� Phone: -
-73
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

I Facility Number: 3 ` --na Date of Inspection
Rtguired
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
El NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
7No❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [3 Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
,�,
La'Na ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
d ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
El NA
rN
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes7No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[I NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
X
❑ 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?
❑ Yes2�N
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
N ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings.
Page 3 of 3 12128104

Z
Division of Water Quality
JT77acility Number 3 r]O 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 �U Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: l0 3U Departure Time: County: DLAMO
Farm Name:
Owner Name -
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: . �a►�ys 11 IA,1 Lam_� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑x Feeder to Finish
1,516 a
S 2�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [= o ❑ d = 4f Longitude: = o ❑' 0
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
IN
Dry Poultry
❑ La ers
❑ 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?
Cattle
Design Current
Capacity Population..
ii
❑ Dairy Cow
❑ Dairy Calf
❑ DailHeifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
M
Number of Structures:
I
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 IJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
❑ Yes ld No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
12128104 Continued

Facility um her: 3 — `]�(} Date of Inspection to
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J.4sotrtC
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
(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 environmentaltheat, 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 Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes [Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ffNo
❑ 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?[:]
YesIo
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JNo
❑ 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):
Reviewerllnspector Name �N�i Phone: _ 3 5
Reviewer/Inspector Signature: Date: o -1.5 to
12128104 Continued

r
Facility Number: — ]p Date of Inspection 10 �5a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LQ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LY No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? if yes, check the appropriate box below,
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
, f❑
LEI No
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
El Yes
I �J to
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
d]
[I NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,�,�
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
FNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ N
[INA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
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
LJ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CJ N
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

4' �.0 ivision of Water Quality
Facility Number O Division of Soil and Water Conservation
J. O Other Agency
Type of Visit 9leoompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit oRoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: Departure Time: County: � Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
D
Swine G
❑ Wean to Finish
�❑ Wean to Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: Cm G
Back-up Certification Number:
Latitude: 0 0 = ' = Longitude: 0 ° = 6 =
Sd
sign ,.Current Design Current
acity� Population Wet Poultry Capacity Population
❑ Layer
j . ❑ Non -Layer
Dry Poultry
IL I Boars I I
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El 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 Cowl
Number. of Structures: W:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
\N
12128104 Continued

Facility'Number: — 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?
St7ture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No El NA ❑NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ 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 ❑ No ❑ NA ❑ NE
maintenance/improvement?
l L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop W' dow1_51��
ElEvidenceof Wind Drift El Application Outside of Area
type(s)
12. crop type(s) hellnme4t 67l'' .
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
l7. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comnnents '
Use drawings of facility to better explain situations. (use additional pages as. necessary): .. r
C� 5,-7 S P'"' �� �3 za
�J
FV
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: d�
pnan 7 of 3 1 . .R/Od ('n�linued

Facility Number: Date of Inspection 8
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ VrUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
4
`
Page 3 of 3 12128104

31 M. -ra
r
pecf Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistanceason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: [� Arrival Time: Departure Time: ® County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Ck, k_ew )} Integrator:
Certified Operator: gLR rkoL b S M�7m _ Operator Certification lumber:
Back-up Operator: Back-up Certification Number:
Region:
Location of Farm: Latitude: = c = ; = u Longitude: ❑ ° = 4 =
Li
Design latm,tDesign Current Design Current
Swine �mwC�aptykttQ° x'PO°I� . Capa E4pulat�op: CattlCapty4Populatioa
AM
❑ Wean to Finish ❑ Dairy Cow
❑ Wean to Feeder ILI Non -La et ❑ Dairy Calf
® Feeder to Finish 5 ]6o - ❑ Dairy Heifej
❑ Farrow to Wean Ury Plry r ❑ Dry Cow
❑ Farrow to Feeder ElNon-Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
El Gilts ❑Nan -La Non -Layers ❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood CouA
= ❑ Turkeys
Other
LJ Turkey Poults
z
❑ Other ❑Other Number�of Structures
Discharges & Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
N'o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EI
IJ N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

Facility Number: — {j Date of Inspection K o5
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?
Structue 1 Structure 2 Structure 3 Structure 4
Identifier: (;tom i
Spillway?:
Designed Freeboard (in): i
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �No ❑ NA, ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [(No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any oft he stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes D No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind/ow ❑ Evidence of Wind Drift El Application Outside of Area
(k•r
12. Crop type(s) y►ltVA C u S& o fv5t-,j
13. Soil type(s) Kumkof-0 11 t S_t-J1_/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
m No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PfNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings oflfaclity�to better explain situations. {use,add.itionalE pages as necessary}:
� � 1 Phon !11
Reviewer/Inspector Name � �, x e.. r-
Reviewer/Inspector Signature: Date: os
12128104 Continued

Facility Number: 31 —7'70 Date of Inspection d.
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
�%
1 No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
IQ No
❑ NA
❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
/Wo❑
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 Inspectionss El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Vi No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L7 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CkPo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
7 `
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�N
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
2NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZN
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El"No
ElNA
❑ 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
0 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
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional.Comments and/or Drawings:
12128104

ate of Visit: 3 Tune:
Facility Number / ��0
CQC o O Not O erational Q Below Threshold
® Permitted ® Certified 13 Condi
tionally Certified© Registered Date Last Operated
or Ab9yIe Threshold: ... ..........
Farm Name: ----- - County:
OwnerName: ....... .... ...... ............ ............ .......... .... _.... _ _ ..� ....... Phone No:.......................................................................................
MailingAddress: .................... ........................................... .................... .....
Facility Contact: ...................-- Tide:.. -- -- - - — - - ---..._.. Phone No: .... ...... __ �� .........
Onsite Representative:.._._ C�O�� .I E'�(% _ ��---� Integrator: ­ &Anl�,,..----�,.......__..---__ �_ ....
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 9 16 Longitude • 6 «
Design Cureent ? _ ;Design Current Design , w Curreiut
Swine = Ca `a Po ulafiori'PoWtry �. ns_ �Ca ci Po alabori._`iCa actpon�w
Ca 60
- - F .. ,
Wean to Feeder
Layer
❑ Dairy
Feeder to Finish--
❑ Non -Layer
❑ Non -Dairy
'Farrow to Wean
Other
E
Farrow to Feeder
_, .
,'u ,1 P s .s
f
Farrow to Finish`'
x Totat Des Capacl<ty _
Gilts
❑Boars:
_
cTotal"SSLW`
f .� � � ��Nuutber of Lagoons
a
�
-
is
Y
-
Po
A'..ry
•�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier. ............
..y.... ......................................... ....-_... .----.......................-----------•----.........._........... •---...............................
Freeboard (inches): 'i✓
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
12112103 Continued

Facility amber: Date of Inspection I I, /Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do -any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Amlication
10. Are there any buffers that need maintenanceJimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Z4,4 z / -- —
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?
Odor Issues
17. Does the discharge pipe from the confinement building -to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
ayes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
:Comments (ref r t€► quesiYon #) �Eipl�sur any YES ns eis�and/or any iernmm_endatioss or�othcr�comments. � :
se-
7 /fle A 6 4rxi,h w x rI PW 14 f Ac*oc3P,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
12112103 Continued

1;acility%Number: 3 _ 77 Date of Inspection
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
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Facility Number Date of Visit:_56 Time:
Not O erational 0 Below Threshold
-Permitted 13 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: B �� County: , u.d/r�"1
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: det, Z Integrator:.0 3
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry []Cattle ❑Horse Latitude 0' 06 44 Longitude 0' & Du
Design Current
Design Current Design Current
Swine Ga aci Population Poultry
Ca aci Po ulation Cattle Ga aci P,a ulation
El Wean to Feeder ❑ La er
❑ Dalry
❑ Feeder to Finish I0 Non -Layer
I I ILI Non -Dairy]
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
Total Design Capacity
❑ Farrow to Finish
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ME]Subsurface
Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No
Liquid Waste Management Sy stem
Bolding Ponds !Solid Traps
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes Rfj�o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 16No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes fl-No
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure b
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 3 — 770 1 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application,
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN �❑ Hydraulic Overload
12. Crop type C-leum �/l 0752�1" c4r_ elwyr4 ( 61W
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?
❑ Yes 10 No
❑ Yes t.No
❑ Yes (-No
❑ Yes RNo
❑ Yes kNo
❑ Yes &o
❑ Yes MNo
CI Yes d!J No
❑ Yes OSNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KVo
❑ Yes JoNo
❑ Yes P$wo
❑ Yes 4kNo
❑ Yes JNo
❑ Yes IQNo
❑ Yes Mo
(ie/ discharge, freeboard problems, over application) ❑ Yes ZNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 'MNo
24. Does facility require a follow-up visit by same agency? [:]Yes 15JNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 9No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.

Facility Number: 71 —77dl Date of Inspection DZ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes Klo
❑ Yes $9-No
❑ Yes MO
❑ Yes &No
❑ Yes �-No
❑ Yes KNo
❑ Yes K—NO
Additional Comments and/or Drawings:
r
05103101

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 770 Date of Visit: 2R1R001 Tie: 14:00
O Not Operational 0 Below Threshold
M Permitted ® Certified (3 Conditionally Certfied 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: lffltl3 County: 11u
OwnerName: HatuldJ................................ Smith........................................................... Phone No: 9.19=5(4- 7..39..........................................................
Mailing Address: Ct�.7.. ..1 A �................................................. . pjmkjm.N.C.......................................................... 28572 ..............
FacilityContact:...............................................................................Title:...............................................•............... Phone No:....................................................
Onsite Representative: Br=t.Mi chelll.HawardSmkk........................................ Integrator: Giddabaro.Hag. jaw......................................•.
Certified Operator:........................................................................................................... . Operator Certification Number:..................
Location of Farm:
Cast of Leon & Hwy 111. On North side of SR 1704 approx. 0.3 mile Northest of SR 1705.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 ' 01 43 a Longitude 77 • 47 30 u
Nirttber ofilet�iara 1 ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
... . ...... ....... .... ......... .. ......... .. .. .. .. .. .........
"m$ Paada l l'rasNoJE Na Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
a 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 10 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 0 Yes N No

Facilitg Nuni►er: 31— 770
Date of Inspection 2/21/2001
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [K No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...................................................................................................................................................................................................................
Freeboard(inches): ............... 28............... .................................... ................................... .................................... ....................
5. Are there any immediate threats to the integrity of any of the structures observed? (ief trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancefunprovement?
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 maintenancelfmprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ( No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes IN No
❑ Yes N No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes M No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0 No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
❑ Yes
09 No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
17. Are rock outcrops present?.
❑ Yes
❑ No
18. Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
❑ No
❑ On -site ❑ Off -site
Required Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
X No
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
M No
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
X No
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
23. Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
25. Did Reviewer/]nspector fail to discuss reviewfmspection with on -site representative?
❑ Yes
No
26. Does facility require a follow-up visit by same agency?
0 Yes
M No
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N No
Odor Issues
28- Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
N No
liquid level of lagoon or storage pond with no agitation?
29. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No

Facility Number: 31-770 Date of Inspection 2/21/2001
Printed on: 3/7/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 10 No
❑ Yes IR No
❑ Yes [K No
[] Yes IR No
❑ Yes W No
�] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewer/Ins ector Name
P
ReviewerlInspector Signature. Date:

Division of Water Quality
p Division of Soil and Water Conservation
Q Other; Agency
Type of Visit ACompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up Q Emergency Notification O Other
❑ Denied Access
Facility Number
Date of Visit: me: Printed can: 7/21/2000
74e`171
Nut O erational Q Below Threshold
)(Permitted Certified ©Con i 'ovally Certified ©Registered Date Last Operated r Above Threshold: ..........
. .Farm Name: �.i County......._. „...................................
Owner Name:.. ................... !rlf. ........0 �7�f'�.1`�L.�/................... Phone No:.......................................................................................
Facility Contact: .....�r'r�..........L!.. .......'Title:...... ........ �Phone No: ...................................................
MailingAddress: ............................................................................... ..........................
Onsite Representative:..... 7LI'1!/ ... ... ........._fib ,Into ��,....���..
/ �' g 7
Certified Operator:,, Operator Certification Number;,,,,,,,,,,,,,,,,,„
Location of Farm:
J `
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �* �� �=° Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish �76gq ,g,&r0 ❑ Non -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 ❑ Lag -In Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made:' ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify 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 krNo
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 KNO
Strut�u ` IStructure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ..........t_.1._._�.................................................... ......................................................................... ............ ........................ ........... ........ .................
Freeboard (inches):
5100 Continued on back

Facility Number: — Date of inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures o erve ? (ie/ trees, severe erosion, ❑ Yes KNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes KNO
(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 JXNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �<No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �Vo
11. is there evidence of 9°er application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload El Yes , o
12. Crop type I,MJ__). 4',V-fi C'\(-,7 A / 1
13. Do the receiving crops differ with those designated in4he Certified Animal -*ante Management Plan (CAWMP)? ElYes %No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes NNo
c) This facility is pended for a wettable acre determination? ❑ Yes 5<No
I5. Does the receiving crop need improvement? ❑ Yes CNo
16. Is there a lack of adequate waste application equipment? ❑ Yes SrNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ;(No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_) ❑ Yes *0
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes IZNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes KN0
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes UNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [XNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes /0
24. Does facility require a follow-up visit by same agency'? El Yes QXN� o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes A No
�'Vo yiolatioris;or ilefcier�cies were poled d&iftgthis*visit. • :Y;oir will-i•eceiye iid fukth&
corres' oridence. about this .visit. . ............ .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name rkill Y se
Reviewer/Inspector Signature: ,94 go/) I/X71 _ Date: 100

Facility#Number: FQ — Date of Inspection
Odor Issue's
26. Does the'discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes (No
liquid level of lagoon or storage pond with no agitation? � K
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, andlor public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �1 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
3123/99

O'Division of Soil and Water Conservation Operation Review T
W
= ©'Division of Soil and Water Conservation - Compliance Inspection
Division bf-Water Quality - Compliance Inspection
(] Other Agency - Operation Review
10 Routine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DS«-C review Q Other
Facility Number Date of Inspection 1571d JCN
Time of Inspection G d 24 hr. (hh.mm)
Permitted ©Certified 0 Conditionally Certified © Registered 0 Not Operational Date Last Operated:
..........................
0
Farm Name: V,_ G$ . �!r..-..... ... County :........ ..... �C_Vlkl�..tfx ................................ .......................
..
fL.....
Owner Name :.---•.- • �I `t Phone No:
Facility Contact: ................................ .................... Title: ---..---....... .. Phone No:....................................
MailingAddress: .................................../. c...............................................................................
Onsite Representative:.�JL..Integrator: ..... ..............
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude �•�� �" Longitude �• �` �"
Swine Capacity Population
❑ Wean to Feeder
IR Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds I Solid Traps 1E1 No Liquid Waste Management System .
Dischari,es & Stream Impac
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
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 Waters ❑ Waters of the State
c. If dischar,,e is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2: Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes kNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes gNo
[:]Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ......... g................................................................................................................................................................................................
1/6/99 Continued on back

Facility Number: —�'"�� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El Yes
ONO
seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
y
tiquid 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? ❑ Ponding ❑ Nitrogen
❑ Yes
No
12. Crop type ,_-...5 ....�_.._Cf"?.� ............................................................................................................................................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14. Does the facility lack wettable acreage for land application'? (footprint)
❑ Yes
�No
15. Does the receiving crop need improvement'?
❑ Yes
NfNo
lb. Is there a lack of adequate waste application equipment?
❑ Yes
�][No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
RfNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
%No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
C91No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes CKNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [�(No
24. Does facility require a follow-up visit by same agency? ❑ Yes RNo
ND vio)ation' s or. deficiencies .were noted. dta;ring.tItis:visit. . You will. receive nc' further .:.
eorrespbridence;about:thisvisit.: •.•.•.•.•:•.•.•.•.•.• .•.•.•.•.•.•.•. .•.
Comments (refer to question #): Exp!ain any YES answers and/or any recommendations or any other comments:=
Use drawings (if: facility to better explain situations. (use additional pages as necessary) _
WAD
Reviewer/inspector Name
Reviewer/Inspector Signature: Date: h/6/99

13 Division of Soil and Water Conservation (] Other Agency
Division of Water Quality
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number G
©Registered O Certified E3 Applied for Permit O Permitted
Farm Name:...... Y.i..... . .........................
OwnerName:................. .� .... ........... ..........1.
Date of Inspection
Time of Inspection ; Qa 24 hr. (hh:mm)
© Not O erational I Date Last Operated: ....................
County:..........................ti......................... I........................
Phone No:....-�v..1 .. 4.:. 3 23..1......................
FacilityContact: .............................................................................. Title Phone No:..................................................
Mailing Address:... ..... L:...1....... .. .0..Y1. ....�1 ...1 `..�\ \�.� �? ....�`..---'--•-'----'........ .........................
�........... ..... l........................:..........
Onsite Representative:.`"a..4-.l,.s��y ............. .. ..Integrator.................... .... .. .........................
Certified Operator................................................."............................. ............................... Operator Certification Number:......
_r V_
l�tll.d Llllll Lll 1' �1 lll.
k.,....... ... 1f:7.... .. t!'4 4A...................................................... .w
.....03...z
rn�`4 .. S3.ti a ....... : ......................................................................................................._................._...................-....................... �
Latitude • 6 0" Longitude • C "
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 14No
2. Is any discharge observed from any part of the operation? ❑ Yes Pff No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑Yes No
c. If discharge is observed, what is the estimated flow in gal/min? R
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 61 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes E'No
maintenance/improvement?
C. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 4No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes kNo
7125/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
KNo
Structures (Lagoon0folding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
'S'No
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: ,-
Freeboard(ft):...........�.:...1.......................................................................................................................................................
.................................
10. Is seepage observed from any of the structures?
❑ Yes
54 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
CKNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
[XNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15 Crop type S9 CI 1-115G
... ..... f............. .............................................................................................................................................................................
...... ...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violationsor derciencies:were' noted -during' this'.visit.-Yo'114 l receive-ito-fiirtlier-:.
c4rr6OOAdehce dliout this:visit:• :
❑ Yes g4 No
❑ Yes O No
0 Yes ❑ No
❑ Yes [9No
❑ Yes O No
❑ Yes [a No
01Yes ❑ No
❑ Yes C�No
❑ Yes Ef No
❑ Yes f,No
I t) .,e,.e. e.►{s ����p ��.-� � � I ��- {-.�+��eq ��(}- -��[/ ,ems a-�t-� � `,�
tiO_ oV- 2. ^c��►-4�
t - ""„ `lL"o�► Gv EG1T �CCI�r id . 7125I97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: <5Tt I S

MAD DSWC Animal Feedlot Operation Review
bs
® DWQ Animal Feedlot Operation Site Inspection _
As
w.
10 Routine 0 Complaint 0 Folks -up of DWQ inspection 0 Follow-up cif DSWC review 0 Other
Date of inspection
Facility' Number '3 "] 70
Time of Inspection / b 2.4 hr. (hh:mm)
0 Registered Certified © Applied for Permit 0 Permitted [3 Not Operational Date Last Operated:..........................
Farm Name• ��;.Hy Nzec.V—Y..........rQ+"tx.................. county: ........ lbvp ! ........ ........I........
Owner Name:......4......tn!'�11,...................... aZaY.-..3.73°.....................................
Facility Contact: �•r A .......... Sj ..9. Title: ............ .................................. Phone No: �91-���8-�734
L
MailingAddress:.... `1�..... L.... 1�.......... iiST............................................ .......... .i.c,................................... z. . --
Onsite Representative: ...... kwcao........ :5o.1'i.AV........................................................ Integrator :...... C2. 0.US. ..... .......... ..................................
..-.-
Certified Operator ;......... rite[nl[1--------- .......&i.......................... Operator Certification Number:--.-.7�
.............
Location of Farm:
a�.....QQ3 ..t�Cr�n........:P.tvl ��4hA r��Yi.��1t.,....1 Urn.. r car... .I AR4 ...hut �r...�Q......�,�... .i7QL�..`T�r..n............ 4......... ...... r�
An ...... 1^11-.^..^ry.N�1s�- ...T� ...r' ...An.gKA- s..'.-Tur.�n...ie.�. ...�r ....SCR..17.o.4,. x,xM...... '.--1.^.[dj: 3x�4itts...on. ......... .
f - --1 .. 1 7C 1a rt 1 1 iF L-3 i -. ._.]- 7 'l. 0 ,I 1 r I[ f 1, nai� y.+4J1 Si �- +e 'F
saruua•- I / 1 L.. -V.1 ! 1 1-3 ! a....a1 aa++•. a, L-- ! 1 1 1 T 1 1 E I
Design Current Design Current Design. Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity -:Population `
❑ Wean to Feeder
JEI Layer
❑ Dairy
Feeder to Finish
JE1 Non -layer
❑ Non -Dairy
El Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
S -7&
❑ Gilts
Total SSLW
77 (900
❑ Boars
Number of Lagoons/ Holding Ponds JE1 Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? Cl Yes [9No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, dill it reach Surface Water`? (If yes, notily DWQ) ❑ Yes No
c. If discharge is observed. what is the estimated flow in w--al/min? N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. is there evidence of past discharge from any part of the operation? ❑ Yes UNo
4.' Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [PNo
5. Does any part of the waste management system (other than lagoons/holding ponds)'require ❑ Yes No
maintenance/improvement'?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

r
Facility Number: 31 —1-10
8. Are there lagoons or storage ponds on site which need to be properly closed`? ❑ Yes JA No
Structures (Lat=oons,fioldint' Ponds, Flush fits, ete,)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 0
Identifier:
Freeboard (ft): ...........A :.�..............................................
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? (P 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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...... �.Xr.!1k1.L.......... ...... !1�.�1�W�'....------ G r*f........... L l"i............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
No.violations-or deficiencies. were noted during this-visit..You4411 receive no further
correspondence about this:visit:• ; -
❑ Yes RNo
❑ Yes ® No
❑ Yes ®iNo
❑ Yes ( No
PYes ❑ No
❑ Yes 1� No
❑ Yes Pd No
❑ Yes No
'jX Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 14 No
Comments (refer to question #():. Explain any YES answers and/or any recommendations or and other comments. x
Use drawings of faelt#y to better explain situations (use addttt©naI pages as necessary) r
..., _
12. s ors {moan wa,lj shojj 6L rese4j• lR+6 1f, 00r.'�4 5�a�is y
ZZ. S raxhr g skoJf a 6e- 14,�k b, svo�nl guns a+,c Ne-1J 1nv�tbV1%. U�MJ OAS4 a^A(Vsis
Si,o�1�� fie, in '�- (',e►-'�i �i e� ��An. ff
7/25/97
Reviewer/Inspector Name�� W��n
Reviewer/Inspector Signature: _Z�� XL _ Date: