670035_INSPECTIONS_20171231

NORTH CAROLINA ....�
Department of Environmental Qual

(Type of Visit: 7Compliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: J6 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:�.17 Departure Time: County:
Farm Name: 1� tl _1� J Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact:
Title:
Onsite Representative: c
4 t
1 1
Certified Operator:L
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Region:
Certification Number: l q 1 I,S
Certification Number:
Longitude:
Design Current
Swine C•apaeity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pap.
Cattle
Dairy Cow
Design
Capacity
Current
Pap.
Wean to Feeder
I
jNon-Layer I
EE
Dairy Calf
,Feeder to Finish
Dr P,oul_
Layers
Design
Ca aci
C*urrent
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes XNo ❑ NA ❑ NE
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
ONo
❑ 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

Faci6 Number: - Date of Inspection: ho
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L?rNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes JZNo ❑ 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 X No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ 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 'P� 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 PNo ❑ 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 CropWindow ❑ Evidence of Wind Drift ❑` Application Outside of Approved Area
12. Crop TYpe(s): RU KUA4LA, 5c-lI\A1 r,,A,9 , CZY D, . VW'1 UL TSL.tP _ X- YrS"
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes oNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? aYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ONo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2''To ❑ NA ❑ NE
❑ Yes O-No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2�No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: ,�, t-
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard [:)Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FZrNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facitity Number: - Date of inspection: �Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes XNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
,[24
❑ Yes ❑ No
NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ONo
❑ 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 Z 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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
'Z�No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes XNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes JZNo
[] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes C2f No
❑ NA
❑ NE
l5, VC6o� cbvi�in�� �v� �ielcls.
Reviewer/Inspector Name: LC+ rr S I W a�
Reviewer/Inspector Signature:
Page 3 of 3
Phone: `16i (C=7 3 V1
Date: ()
214,12015

Type of Visit: (D 7Routine
iance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance
sit;
Reason for Vi0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 6�,}y✓ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: az7r
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
La er
Wean to Feeder
Non-L,
Feeder to Finish
6
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
eNon-L
Boars
Other I 1 101 (Other
Latitude:
Poults
Integrator:
Certification Number: 17 r7 r7 S_
Certification Number:
Discharizes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes FNo
❑ NA ❑ NE
❑Yes ❑NA ONE
❑ Yes ❑ NA ❑ NE
Page 1 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 [f]No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Identifier:
Structure ]
taller
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
�Yes6No ❑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 environmen 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 E 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
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rNbo
❑ 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 ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis . ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections , 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 ��eN'o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[FaOlity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes o ❑ NA ❑ NE
25."h the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesgNo ❑ 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 V�' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes N ❑ 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 21 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 Z No 0 NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes � ❑'NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes LJ o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comment
s (refer to question_#) Explain any'YES answers and/or•'an addrttonalarecomiiiendadons,or;any other comments..;,
Use drawrns:of facili _ �tob"etteregplarn sttuahons use a ty (` ddittonalpages as,necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phonet 3
Date:

Type of Visit: Q Co pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency. 0 Other 0 Denied Access
Date of Visit: Arrival Time:1�3� Departure Time: County: Opa.4u Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: -9Eq--'V HA L', Integrator:
Certified Operator:
Phone:
Certification Number: I 1 -7 f K
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design CEA
urrent
Dr. P,ouI Ca aci Ro ,
La ers
Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Pouits
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No
❑ Yes ❑ No
❑NA ❑NE
❑ 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 []
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes u Zo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes E No
❑ NA
❑ NE
of the State other than from a discharge?
Page I ,of 3 21412014 Continued

FaciliNumber: - Date of Inspection: all1de.
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?
Structure 1 Structure 2
Identifier:Ux.,V/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
Structure 5
/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[:]Yes No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environm�7o
reat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
6110
❑ 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
10
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ej �N(o
❑ NA
❑ NE
maintenance or improvement?
WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ Yes
o ❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
�7o ❑ NA
❑ NE
❑ Yes
[N ❑ NA
❑ NE
❑ Yes
Na ❑ NA
❑ NE
❑ Yes
wl�e❑ NA
❑ NE
❑ YesVNo
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
D Rainfall D 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 VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Flacili Dumber: - Date of Ins ection: I S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
io ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No [] NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
o ❑ 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
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
❑ NA
9�0�Fj
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments::
..
Use drawings of facilitv to better explain situations (use additional pages as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
4

N' Type of Visit: nutine
liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County:! Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: '&, VT P Au, _ Integrator:
Certification Number: % I In
Certified Operator:
Bach -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
Cattle
Dai Cow
Design Current
oM
C►apacity Pop.
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Design C►urrent
D r Poultr Ca _a_ci P�q
La ers
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Da'
Beef Stocker
Gilts
Non -La ers -
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes P
No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
;,'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes OlNo ❑ NA ❑ NE
r
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
It any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmZal threat, notify DWQ
7. Do any of th
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Zo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes yl�e❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ YesVNo ❑ NA ❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available? El YesWW
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yeso ❑ NA ❑ NE
the appropriate box.
❑WUP [—I Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �/ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
e structures need maintenance or improvement? ❑Yes o ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? [:]Yes�No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes [�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 Panding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals (Cu, Zn, etc.)
El PAN El 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):
Page 2 of 3 21412011 Condnmed
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Zo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes yl�e❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ YesVNo ❑ NA ❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available? El YesWW
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yeso ❑ NA ❑ NE
the appropriate box.
❑WUP [—I Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �/ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
e structures need maintenance or improvement? ❑Yes o ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? [:]Yes�No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes [�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 Panding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals (Cu, Zn, etc.)
El PAN El 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):
Page 2 of 3 21412011 Condnmed
❑WUP [—I Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �/ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
e structures need maintenance or improvement? ❑Yes o ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? [:]Yes�No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes [�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 Panding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals (Cu, Zn, etc.)
El PAN El 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):
Page 2 of 3 21412011 Condnmed

Facili Number: - Date of Inspection:
!I!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 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 FNo
N ❑ 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:
❑ Yes No ❑ NA ❑ NE
❑ Yes U /No ❑ NA ❑ NE
❑ Yes 5 o ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
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 0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes rjo ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon( !
Date:
2/4/20I

Type of Visit: U Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 6PSl.6 hJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 20Ut Al. —
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design C•ucrent Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
La er DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
y�-b
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design C+urrent D Cow
D , P,aultr C•_a aci_ P,o , Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
jLL
Turke s
Turkey Poults
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑ o ❑ NA ❑ NE
[:]Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: i) Is III
Waste Collection & Treatment
4? Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [2/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? EYes 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 WNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesrNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
No
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 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 rNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of inspection: g
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑Yes Lon❑ 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 ZNo ❑ 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 inunediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes EfNo ❑ 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?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
[�No ❑NA []NE
['�No ❑ NA ❑ NE
��No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or, any additional recommendations or. any: other.comments.
Use drawings of facility to better exnlain situations fuse additional Danes as necessarvl.
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone:( !h)m C-75 D 1
Date: 3 113
21412011

Type of Visit: Q CCpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency_ 0 Other 0 Denied Access
Date of Visit: Arrival Time: 5Ox5 Departure Time: County: CVV 6D Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: 4U_
Certified Operator:
Integrator:
Certification Number: 19 ?? S_
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C•urcent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
C►attie Capacity Pop.
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Design Current
wm. P,qul Ca _aci P,a
D Cow
Non-Dai
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other —I
Turke s
Turkey Puults
Other
Discharges and Stream Impacts
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 -wade?
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 Cl/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ,N ' ❑ NA ❑ NE
[—]Yes VNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - 5 Date of Inspection: dLl 'Zr
Waste Collection & Treatment
,4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E2 /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 40
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes e 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 environment hreat, 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 C21No ❑ 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 no ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes U /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 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
❑ Yes
VNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
VNo� ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0<0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and l"Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VO
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: &- j Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
'25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CfNo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
jNo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C 1"" ,E] NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�.d" o ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any otber comments:;
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
l_
Pho43 16 6 "
Date: C12-
214/2011

Q DIVlslo
3� _Q Dlvlsio
0 Others.
Facll;ity Number;:
{orj
of Water Qeiahty
of Soil and- Water Conservatlo
enev
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 44�p
Arrival Time: ® Departure Time: County: GIt1SLo 1V Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: "J� i.V Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o Longitude:
" Design Currentx r rt a a a Design Cnrrentr ��rr"v DeSlgil Cnl Cent
Swine ff ,apa Po elation Wet 1'oult Ca aci Po Matson rx Cattle' C
P t3 A P h p: _ ' spacsty Population
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
�ILJ Non -
El Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
i
❑ Yes No ❑ NA ❑ NE
❑Yes
❑No ❑NA
❑NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No. ❑ NA
❑ NE
❑ Yes
❑ Yes
5K0 ❑ NA
❑ NE
❑ Yes
L'J No ❑ NA
❑ NE
12128104 Continued

Facility Number: !35
Date of Inspection 1 1
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: WTCt911 -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 j
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ld 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 thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ElNA ElNE
8. Do any of the stuctures tack adequate markers as required by the permit? ❑ Yes71�ElNA ❑ 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 L No []NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes E No ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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?
❑ Yes❑
NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
�13 o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
X�o❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
� � ;� -�
Comments (refer to.question ft Explain any YES answers and/or any..recommendat ons or any other comments
Use drawings of facility to better explain_situatiork {use.addrtional pages as necessary)
T
Reviewer/inspector Name cJ / :I we-- GZ °. �:: Phone: 7Q� 3
Reviewer/Inspector Signature: Date:
f 12128104 Continued

L
• Facility Number: '� — Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
Ld No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3 No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
O/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
d o
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;FN
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
4o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E2"No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
W<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
WNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments andbr Drawings: a"' pz.
Page 3 of 3 12128104

�1
Faclitty Number ; (o'"]
Division of _Water
t
Conservation „
Type of Visit ,Co
0pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date.of Visit: Arrival Time: t {7C7 Departure Time: L—� County: tWSLOO Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ec-R---t „14o, Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = n = 1 = « Longitude: ❑ ° = 6 = i!
Design Current - Design Current<{ Desrgn Gurr ne t�
�aSwine .apacity "Population Wet Poultry "Capacity,'i'opulation Cattle _ Capacity P.opul'ation
❑ Wean to Finish ❑ Layer El Dairy Cow
a
❑ Wean to Feeder jE1 Non -Layer I Dairy Calf
Feeder to Finish -M 6 w; ❑ Dairy Heifer
❑ Farrow to Wean " x ❑ D Cow
❑Wy, Poultry -„
Farrow to Feeder " "` ❑ N D
Farrow to Finish
e ❑ Gilts
❑ Boars
❑Other �.
on- a�
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number;oftStr..... s: �
_ �..
❑ Layers
❑ Non -Layers
❑ Pullets
s
❑ Turkeys
❑ Turke
[:3 Other Ej
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2, is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes E� No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ NA
El NE
❑ Yes
El Yes
7NO [I NA
❑ NE
El Yes
l No ❑ NA
❑ NE
12128104 Continued

ti
r
cj Facility Number: (0— 3S
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAGanAJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4b
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 2 o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tEi�reat, 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 24 ❑ 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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste AnDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ 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
,0"'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�Zo
❑ NA
❑ NE
Comments (refer to question;#):; Explain any YES answers and/or any recommendations or_.any ether comments -
Use draydngs,of facility to.better explain situations (use additional pages as necessary)
4 ..
Reviewer/Inspector Name �1.noNds ., Phone 9ZD G—Mg
Reviewer/Inspector Signature: Date: D
Page 2 of 3 12128104 Continued

M
t
Facility Number: — 3S Date of Inspection
Rectuired 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 El Other
❑ Yes o ❑ NA ElNE
ElYes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ld 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 [I Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[/To
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
o
❑ NA
ElNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0/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
Z 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
E2 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
EI
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
[Io .
❑ NA
❑ NE
Addittonal.Comments..andlar Drawings;
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit 0Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: :• t$ o I Arrival Time: �' bO Departure Time: County: dMs(,a ►./ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: QEef gqu„ Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = = = Longitude: = ° = I = 46
Design Current
Design Current
Design Current
Swine Capacity Papulation
Wet Poultry C>apactty Population
Cattle Capaci#y Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
q:�p
❑ Dairy Heifer
El
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
El Boars
El Pullets
El Beef Brood Co
❑ Turkeys
Other
❑ Other
El Turkey Pou Its
El Other
Number of Structures:
a
Farrow to Wean
Dry Poultry ❑ D Cow
El Non -Dairy
❑ Layers
❑ Farrow to Feeder
El Farrow to Finish
El Beef Stocker
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
❑
❑ Yes
❑ NA
❑ NE
❑ Yes
LI No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number:
Date of Inspection
11
Waste Collection & Treatment
jNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LA CGS /J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
dNo ❑ NA ❑ NE
8. Do any of the 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
El Yes
-- //
ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
ElLT Yes
,�,/
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,�(
lJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Zo
0 ❑ NA [I NE
15. Does the receiving crop and/or land application site need improvement? El Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes d�jo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
VNCI
El NE
18. is there a lack of properly operating waste application equipment?
El
NA
❑ NE
.Cm oments (refer to.question 0 Explain aby YES -answers and/or any'rec©dtmendatrons or anyiother comments ..
-Use drawrngs;of facility to better ezptatn situations (use addihonal pages as:necessary)
_ n
C4Lt$rzArr.4✓ AWe dVr TAPS° c Avar SW r Fx DWO
raoe,F ooivc 13ur mpeltivon-1- )VOT SENT', T-A,"- 1011rf
Reviewer/Inspector Name Aj f;4o-'A)1— I Phone: `1A0_ 76 - 3Y
Reviewer/Inspector Signature: Date:
Page 2 of 3 I21I8/04 continued

Facility Number: — Date of Inspection o2 0
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 appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
❑ Yes 21/No ❑ NA ❑ NE
❑ Yes 0 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 I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
['No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
12 YYes
❑ No
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
�
�QYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ETNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [3"No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L2<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ffNNo
❑ 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
CY o
❑ 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
l.d<o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E,14�o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12.128104

Type of Visit 6 C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I s Arrival Time: l 66 Departure Time: County: 6MSt.6w/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 3C-2T 9AuL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certifieation Number:
Latitude: [ o [= I =. Longitude: 0 ° = =
Design C►urrent Design Current
Swine Capacity Population Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
® Feeder to Finish
2
6G
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ La ers
Non -Layers
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Finish
El Beef Stocker
❑ Gilts
❑ Boars
❑ Beef Feeder
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
I
❑ Beef Brood Co
Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 [7/No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes � El NA ❑ NE
ElYes 7Noo ❑ NA ❑ NE
Page I of 3 12128104 Continued

t�
Facility Number: — S Date of inspection s •
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JZJ 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: I jA eryo A)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
2fNo ❑ 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?
�s
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
,❑,/No
L( 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
dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E 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 UNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes l"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 2 rvN
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes �J }V
❑ NA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes o
❑ NA
❑ NE
^'.`+oMtr.^a.,i'k'°v'6.C' it.rb'i 1. 341r1 •• 'i'� _ �J - "
Comments {refertnquestton#)Explan^ ayYE nswesanr any cecAvmmendahons or any, other comments.
:Use dr�akwmgsh of factuty to:better.explatn-situanons (use-additional!ofi s as,aecessary.)
�•.r�ae4.� .tiii°,�Al:K. �!.'yg..# �T .'9AS:�N��le� 4477 i[,-
v , . ' -
�.� Ar�q a� JDIK WALk 13Al2
Reviewer/Inspector Name ( Phone: Q/b --73�
Reviewer/Inspector Signature: Date: r '?14 J
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection 6
,s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNp ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C3 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections /❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �❑ N ElNA ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes L"J No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L j4 ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes <o ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes bN--o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No dNA ❑ NE
Other Issues
�
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
.E No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
`Co ❑ 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
o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
N
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
a ❑ 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
[I NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes❑
7No NA
❑ NE
Additioinal Comments'and/or Drawln s. -
Page 3 of 3 12128104

IF
Facility Number (�
LdDivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: I/St 0 Arrival Time: �]Qb Departure Time: County: cW,9_01`2 Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: tLAt-W Integrator•
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: o =1 = Longitude: [� o = 6 +
Design Current Design Currents,
_Swine Capacity' PopulationWet Poultry Capacity Population Cattle Caj
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
12,449
1 fA pg:>
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
I
❑ Gilts
❑ Boars
Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures ,ti
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 :N ❑ NA [--IN E
El Yes LJ No ❑ NA ❑ NE
12128104 Continued

34
Facility Number: 0 — __ Date of Inspection l 3l
WiBste 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: I,AG aajnJ
Spillway?:
Designed Freeboard (in): 20
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
LJJ 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
C2No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
C3"No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
O 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 El Yes
/
2 o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes
D f o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ICI 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
VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LEI No
❑ NA
❑ NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[30-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ 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):
u F flA'tE 5rau�f�G Fo 2.,,,�
Reviewer/Inspector Name �ay 1J A Phone{ 9ld)796 -73 fV
Reviewer/Inspector Signature: Date: ! 3 d
page 2 of 12128104 Continued

Facility Number: 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. ❑ XVT Tp ❑ 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 ZfoNo ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes LJ 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
9<o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P
[3 NA
❑ NE
Y h
26. Did the facili fail to have an active) certified operator in charge? El�Zo Yes❑ NA ElNE ' /
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElYes ElNo O NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I�To
[I NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
�
El<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C2<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,��
FTNo
❑ 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
Wo
❑ 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

f
Facility Number 3 S
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit C�Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit &Routine 0 Complaint 01=ollow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: b v(s Arrival Time- Departure Time: County: f1WL0k) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: jj&fLT 44ALL integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑fOther
Phone No:
Operator Certification Number:
Back-up Certification Number: -
Latitude: [= o =1 Longitude: o
Design Current- Design,-,- Current'.: Desig
Capacity Population Wet Poultry . Capacity: Population ' Cattle Capac
❑ Layer
❑ Non -Layer
a�wr !! -
Dry Poultry
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
F Number of Structures C
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 3 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes d o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection ! da
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes dNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA Z Dmw
Spillway?:
Designed Freeboard (in); ILO
Observed Freeboard (in): 1'4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes WNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [?(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �,�
9. Does any part of the waste management system other than the waste structures require El Yes L1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 3{r `.) V (,&� S 6 0 CS Su OWA
13. Soil type(s) 6"1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? 2 es
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
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
a No ❑ NA ❑ NE
7NO
❑NA ❑NE
❑ 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):
wUP Ar'►N,m&omxNi tJoNb 04lOM 1 WZ1N Ccum_rTC13T whsf6
Il1Vr4L-yVL3 43 MENrwE
-1nl rz-�Jsau S+JSPEci�TI
LoJr U� F on,TS �►.! wE� 4 C9r.]z � 0' (BQ% vY"UO sa 1i;-11�-tA CNur �
Reviewer/Inspector Name �4' j �L
Phone:
Reviewer/Inspector Signature:
Date: S (�
Page 2 of 3 1 12128104 Continued

,[Facility Number:ca — Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E! No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
f
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
7wo
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
M N
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[I NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
VN
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
EJ 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
O 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NVN
[I NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional Comments and/or
Page 3 of 3 12128104

r,
i ype of visit Qy-Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time:
Departure Time: County: oSW_l,.i_ __ Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative- ��T 4�A1 t� Integrator: r-,U( --P 14y
Certified Operator: _
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 6 = Longitude: ❑ o ❑ . = {1
Design Current
Design Current Dram
esign Current
Swine
CapacityPopula
oultry
CapacrtyPopulation_ CattleF Capacity 1'opulaton
❑ Wean to Finish
J
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑Non-Layet
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
❑ Farrow to Finish❑
Beef Stocker
❑ Gilts
❑Non -La Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood CoNd
❑ Turkeys
OtherTWO
Turkey Poults
❑ Other I JJJEJ
Other
Number of Structures: E]
Dischah r2es & 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 discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
ElNA
I —]NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
R N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: (p� — Date of Inspection S 3 S
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: cmcoN
Spillway?:
Designed Freeboard (in): 20
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?. ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E?CNo ❑ 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) ,y�
9. Does any part of the waste management system other than the waste structures require ElLI Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) S,1DAr-) �'ESc.t)fc
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[JNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
ElNA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[[
Yes
Ll No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
b. ) 1,�uP 14A5 VCSWE ?t P � w �o�LSkPT -�)oJ ��Eii- RvR) 56lnul.b 6k gCA6tL"?
S6o A00 9v0H0 WEDUCTt_aj
MR-? Lo- 4 UAS ► -T- CoQEri-ED AfE&Sl` TAkk CA(Lf_ 1.50 aCPZla[ UG To DrV%(: 1rJAS` C
A r ALE S.CS .
Reviewer/Inspector Name t�af�i q L, °- _ Phone: 39$•-3gOay��'�
Reviewer/Inspector Signature: Date: :53 oS'
I2/28/U4 Continued

Facility Number: Cr) — � Date of Inspection S 05
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 appropirate box. dWUP ❑ Checklists ❑ Design❑ Other
El
❑ Yes �No ❑ NA ❑ NE
eyes ❑ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
o
❑ NA
❑ NE
Waste Application ❑ Weekiy 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
r
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Zo
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
�A
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
WNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
DNo
[I NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ON.
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
%[ �N,o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EJ No
❑ NA
Cl 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
Cl 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?
El Yes
�,�
l< No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
i-- y
Additional Coinmenfs'andlorDrawings
12128104

Type of Visit PrCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Qf Routine O Complaint O Follow up O Emergency Notification O Other
Facility Number Date of Visit:
Permitted [3 Certified © Conditionally Certified 17 Registered
Farm Name: ....fie7....i......IG'Q/tl ..............- .................
Owner Name: _... ,........�......... I.. ......
.
Mailing Address:
Time:
❑ Denied Access
10 Not Operational O Below Threshold
Date Last Operate or Above Threshold: ---_...._ ...............
County:..._..1� .».................. ...
Phone No:(ello)
. . ..........
Facility Contact: Title: _ _.... .. .. _.. Phone No:
.�T-r. __ _...._ ..... �. W�
Onsite Re resentativee/ _._�!� _.__.. Integrator: •„----_
Certified Operator:
Location of Farm:
Operator Certification
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' 41 Longitude • 4 «
Car:nn
Wean to Feeder
Feeder to Finish
SOQ
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
❑ Layer
❑Dairy
❑ Non -Layer
❑Non -Dairy
-
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Jof No
Discharge originated at. ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes 0 No
Structure 6
Identifier: ......... . ........................_........................... ....................................
Freeboard (inches):
12112103
Continued

FacQy Number: -35 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes 21 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 0 Yes W(No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 0 No
8_ Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 0 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes J� No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 2 No
❑ Excessive�P+onding ❑ PrAnN,, ❑ Hydraulic Overload [I Frozen GGrr and ❑ Co r and/or7inc
I2. Crop type Bf2irVll)A l ('f�� , C.t�P/� .SI,QE/p�s ✓tl/� '�C= `.��F f(.zf� ���'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes PfNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes 'ZNo
16. Is there a lack of adequate waste application equipment? ❑ Yes ;ZNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ;yNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes A No
Air Quality representative immediately.
12-drarv�ngs of fac�tq W better explara sttttat,ons{use;acld.t;onatpag as necessary) Feld Cop Fu al Notes
A,
r
�, - m ; .n .
ReviewerAnspector Name " ' -
_ _
Reviewer/Inspector 5ignatu Date: / O
12112103 y Continued

Fae`Uty Number: Date of Inspection
Required Records & Documents
21. FaiI to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes VNo
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 XNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A 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 ONO
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?
(ieJ 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 XNo
\'PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes )yNo
3I . 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 ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
[3 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
'V3) VA
Joe
12112103

Type of Visit 'eCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: % 31 4 3 Time:rO
� 3 .$
Not Operational 12 Below Threshold
O Permitted O Certified ©Conditionally Certified Q Registered Date Last Operated or Above Threshold:
r
Farm Name: r.> E.�. " P �� 1� 6 " - County: b
Owner Name: ✓ ki/C-1 /( Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Ee'-4_ 1/r! IL --
Certified Operator:
Location of Farm:
Phone No:
Integrator: ''_d_L,"Kkk
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �' " Longitude 0 4
Design
Swine C*a acity
❑ Wean to Feeder
Current
P,o ulation
Design Current
P,©ultry Ca aci P,o ulation Cattle
❑ La er ❑ Da
Design Current
Ca aci P,o ulation
❑ Feeder to Finish
❑ Non -La er
❑ Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
TOta)I Design Capacity
TOtB)( SSLW
❑ Farrow to Finish
❑ Gilts
❑ BOars
Number of Lagoons �.J ❑Subsurface Drains Present ❑ Lagoon Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management S stem
❑ Spray Field Area
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?
Was Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: j
Freeboard (inches): 3 Z
05103101
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes Z No
❑ Yes E`NO
Structure 6
Continued

Facility Number: 6 n — 35
Date of Inspection
S. 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 stuctwes 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 'Gt v- v'l v d.{ rz rq Z � ` Co • -% 3 So -I t 0;rl ✓F S/ 'v 0( *1 h t� eti, CS ? I( XJ C S je-'rsG L r
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?
Reouired 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/ WLTP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes , T-eTNo
❑ Yes A No
❑ Yes 10 No
❑ Yes ;'No
❑ Yes PNo
❑ Yes jo No
❑ Yes JC3"No
V -ZkZe
❑ Yes /ffNo
❑ Yes XNo
❑ Yes gNo
[:]Yes /ONo
❑ Yes O'No
❑ Yes Z No
❑ Yes,ZNo
❑ Yes ZNo
❑ Yes XNo
❑ Yes RNo
❑ Yes 0 No
❑ Yes ❑i'ND
❑ Yes 2rNo
❑ Yes Z�No
❑ Yes P�No
r] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
T -:- ....- r.•ib3Y .h':tiG 5:+a' ',.rv, � 1-•.1 n iV� ,q� 3
Comments (refer to,questton #}. 'ERplam any YES answers:and/or any recommendations o� any other c©mments:;�_
Use drawings of facilit3 to better explain situations. (use addrhonal pages as necessary)
❑ Field Copy ❑ Final Notes
u, .. .. . � � ,:
s .' i' .t tJe 11 kCr4. �J�C Jc/s ah, Fs, t.,� 11 yam► �, �''��c, �'r-,eGd
J
e 1-j0? e.I ),i � 1i 3"�,e l� � h C'f 41,, r')c e ZY t l e H A c )P 4.
T 1+ � �c, � ► ., � +^ rj o d �� � �C .�.
�a r-► k � O i-. �0 '✓ � p LI ✓ c Ace S 4O /n 4y s, 4,,�, J n77
Reviewer/Inspector Name- p nt t,J.yt r1q 4 Ai s ` `'
Reviewer/Inspector Signature: Date:
05/03/01 Condnued

Facility- Number: — 35 Date of Inspection
Odor Issues
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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Ef\o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 06 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? [--]Yes ZNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
orb roken fan blade(s), inoperable shutters, etc.) ❑ Yes gNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes O'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
[Additional Comments and/or;Dra►vings:
05103101

0 Permitted ❑ Certified 13 Conditionally Certified © Registered
Farm Name: 73er4 H41j F .,,
Owner Name: 'Fe', � /7 ei% %
Mailing Address:
z di Time.
rO Not O erational 0 Below Threshold
Date Last Operated or Above Threshold:
County.
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: fie'" ak Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �� �• 0�
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes ONO
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 ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State otbet than from a discharge? ❑ Yes No
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes_,ZNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Freeboard (inches): `*•
05103101 Continued

Facility Number: 7 — 35 Date of Inspection Z 02
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes ZrNo
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
El Yes ONO
immediate public healtb or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes Z'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes 'ETNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ETNo
Waste Aonlication
10. Are there any buffers that need maintenance/improvement?
[:]Yes �NO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes XNo
12. Crop type-<VArAr% �j,-RtS� �$G G_-z,Se-^uL1Ab�'aZ[�� Sr-.o�lt1_
V-ni
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ YesNo
14. a) Does the facility lack adequate acreage for land application? `S� NJ bA ns TD b ti � c 0
❑ Yes/�N0
b) Does the facility need a wettable acre determination?
❑ Yes ONO
e) This facility is pended for a wettable acre determination?
❑ Yes �No
15. Does the receiving crop need improvement?
Yes 00
16. Is there a lack of adequate waste application equipment?
❑ Yes �To
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
JZ'No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ❑ No
20. Is facility not in compliance with any applicablg setback criteria in effect at the time of design?
❑ Yes_,0"No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes )2Mo
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes2Jo
(ie/ problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes xJ No
24. Does facility require a follow-up visit by same agency?
❑ Yes lff�f o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes�ZNo
LP No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments:(refer:to question ) Ezplatn-a ,YES answers and/or_any rei ammendations.or anv.other-"com_ments
_ _ -
[Ise;driwings of facility to better explain situations: (u additional pages as tee essary) a ❑ Field Con, � ❑ Final Notes
-FIeAse wer1- 4o !m ►,o✓e -the s4lveid of 6e✓'mudm at, pv1)s 1 �Z
P(eGrre q Ise L4,P4 �d ve 4e 54APL f of : s4ve Dh vil /1-
I Gavey AF O
71V11�
a llG o;i 6yj vl! la- Tip e-ewi pw< er,e wqs a►�i�e LAI/
-4k g f i f more 74k4rn L o dA y s �elpp l -Ae e/ r�
Reviewer/InspectorName - .;�
Reviewer/Inspector Signature: Date:
05103101 Continued

1 Facility Number: 6r7 — 3 Date of InspVctinn 2
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 permanentltemporary cover?
AYes ❑ No
❑ Yes�o
0 Yes �To
❑ Yes -P'vo
❑ Yes O'No
❑ Yes o
❑ Yes ❑ No
Additional Comments and/or DrawiMs:,
�'I►�. l-��1�'S QPe�^��ivn ��d �eto�ds ar*e t/er y a✓e%1
J
05103101

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: Time: 19 4S I Printed on: 7/21 /2000
0 Not Operational Q Below Threshold
Permitted C1 Certified��,,13 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold- ---------------
Farm Name: ...&AA-. �'` ] ........... Countv: Q K G 1� ...................
................................................ .
OwnerName: ................................................... ........................................................................ Phone No:
Facility Contact: .............................................................................. Title:................................................................ Phone No:
...................................................
Mailing Address:............................................................
Onsite Representative: Q\—J.`Q .-'..�
..........................................
Certified Operator:....
Location of Farm:
..................................��tr........................I......... ..........................
Integrator:.. ................
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude 0 6 66 Longitude • t 66
Caber Po rilat,on ry, .: Ca -a, _.
gn : ` Current Design Current
Point ci Po `alatioi Cattle _
Wean to Feeder
eerier to Finish
'a
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
❑ Layer ; ❑ Dairy
❑ Non -Layer ❑ Non-Dai
r❑ Other
Total Design 06il bi
:Total SSLW
P>s�ber>Lpo�❑Subsurface Drains Present ❑ Lagmn Area Spray Field Area
H Pon&'I SohdpTraPs ❑ 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 O No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XfNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................................................................................................................................................................... ....................................
Freeboard (inches):
5100 Continued on back

.r
w )Facility Number: — �b I Date of Inspection Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? Get 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 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
—11
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes 6�No
❑ Yes J_,'i�No
❑ Yes t No
❑ Yes tq No
❑ Yes t4 No
❑ Yes j� No
❑ Yes No
❑ Yes ([No
❑ Yes �Q No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes allo
❑ Yes D(No
❑ 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 XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 'M No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes t[ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 0 No
22. Fail to not regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes gNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 14No
ON iolatigiis'© dgfciei�cies wire noted during this:visiti Y00 w1114' 906 do fui-tii�r
cories o deuce: about this :visit
eo>aiments (re or to question #): Explain any YES answers and/or any: recomn�nda4aons or any attier co .
Use drawings:of faiaiity to'better explain sitttations (use additional.pas 74—
¢r (� 1 [ r
i� �e. � C-act,-�e;�- p���-_�-'.►--� �.. pt.`-� i �-� 't`� +��.e �ey�� � �-e�-�� ����'-`�
Sr,w.p— �aU ►�,�1��1`fQ c. w�j p� c �`- mecca► 1 `��^/ Siege
�w�c'�.9 ko
Reviewer/Inspector Name QW"tPC
Reviewer/Inspector Signature: Date: L CI t 5/00

Facility Number: r] — 16 Date of Inspection CY l Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
KYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
kNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
�fNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
ONo
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32. Do the flush tanks lack a submerged till pipe or a permanent/temporary cover?
❑ Yes
No
Additional otLmments an ((or .ravings: - -
0
5100
J

Division of Water Quality
0 Division of Soil and Wa
ter Conservation
- 0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine 0 Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: ®'CuL i__1�-�
nt: Printed on: 7/21/2404
Facility Number �j
0 Not Operational 0 Below Threshold
Permitted © Certified © Conditionally Certified © Registered Date Last Operated or A ove Threshold: ...............
AFarm Name: '.K �. County:........ °i"..............................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: .. ............................................................................ . ritle: ................................... Phone No:...................................................
MailingAddress: .......................................................................................................................................................................................................... ..........................
Onsite Representative. .-.Q1........................................................................... Integrator:........................................................
Certified Operator : ................................................... ......................................................... Operator Certifica___ti���-,nGGGNumber: ..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' b= Longitude • 6 «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle apacity Population
❑ Wean to Feeder 10 Layer I I Dairy
Feeder to Finish- a ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ soars Total SSLW
Number of Lagoons I I I I[] Subsurface Drains Present ❑ Lagtkan Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Disci & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/min'?
d- Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......................................................................... .
Freeboard (inches): 3
5100
❑ Yes JxNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
Xj No
❑ Yes
�&No
❑ Yes PNo
Structure 6
Continued on back

,i
'r Facait Number: / Date of Inspection Y E� T 3 P Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes b(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
PKNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
P�No
11. Is there eviden a of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
,N No
112
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
j
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[O<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
jgj No
16. Is there a lack of adequate waste application equipment?
❑ Yes
I" 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
gNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
KNo
(ie/ discharge, freeboard problems, over application)
❑ Yes
23.
Did Reviewer/fnspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
.� No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
PJrNo
0: Rio vi6latidris:or• deficiencies were n6€ed• d&itig this:visit.' - Y;ou will •receive tip: ]Further • ,
comes' oridence: agouti 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): j [
e CG �. ��� S�.t�-.�lL2s i� �,pn.�i ,•-� Q,�f, �r,Ls or1-� v�s��I G� �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
I•
Date: C oZ (_00 5100

'rf Fatility Number: — • Date of IEispection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Atlor below xyes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes '"No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'x No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
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 *o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes qNo
32. Do the Bush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes $:(No
Additional Comments and/orDrawings: _
5100
5100

FG Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSN C review Q Other
Facility Number 3 Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted ❑ Certified E3 Conditionally Certified © Registered j3 Not Operational Date Last Operated:
Farm Name: .... 1...-............................................................. County:C .J. cw—............................. .............
..........
OwnerName:... 2v ........................................................................ Phone No: .......................................................................................
FacilityContact: ..............................................................................Title:.......---.---....................................---.......---. Phone No:...................................................
Mailing Address:
Onsite Representative: ..................
CertifiedOperator: ............................................................................................................
...... ... ....... 1-•---
..
'..................................................... ...........
Integrator: „ C\'��! ..........
Operator Certification Number
M F y - -A
Latitude `4 .4 Longitude C • 4 °°
Design Current Design Current Design Current -
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 10 Layer E= JE1 Dairy
Feeder to Finish r- El 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 ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream ImimeLs
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 dischargc is observed. what is the estimated flow in «aI/min?
d. Dods discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier: n
Freeboard (inches): ..........3.V .
/6/99
Structure 3 Structure 4 Structure 5
❑ Yes
kNo
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
9fNo
❑ Yes
[(No
❑ Yes
KNo
Structure 6
Continued on back

PrFacility Number: 6� —�� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [:]Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? 4 ❑ Yes 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
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes X No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑Yes '(No
12. Crop type ............ S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes M No
15. Does the receiving crop need improvement? ❑ Yes 'No
16. Is there a lack of adequate waste application equipment? ❑ Yes P<No
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes XNo
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes gNo
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
aYes ❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes WNo
21. Did the facility fail to have a certified operator in responsible charge?
❑ Yes ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes XNo
23. Did Revicwer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes EfNo
24. Does facility require a follow-up visit by same agency?
❑ Yes E`No
1. N.o AWaitions:or. def dende's .were nofeid daring t)iis:visii:.I'nu will.relceive nu further .:.
c-orresparidence: Abfif this visit.; - :: ; ; :: ; ; :: ; ; ........
Comments (refer to question #).- Explain any YES answers and/or -any :recommenda_bons or any other.comments.
Usedrawings of facility to better explain situations. (use additional pages as necessary)
Y-e� V +/� `
�4141
Reviewer/Inspector Name '
Reviewer/Inspector Signature: 1���� — _ _ Date: J� 1 Y _11 1/6/99

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number �r - SS Operation is flagged for a wettable
Farm Name: �L. tom. acre determination due to failure of
On -Site Representative: Part 11 eligibility items) F1 F2 3, F4
Ins pectorlReviewer's Name:
Date of site visit: #
Date of most recent WUP: S ar7
Annual farm PAN deficit: pounds
Operation not required-xo secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: D hard -hose traveler, 2. center:pivot system; 3. linear -move system;
4. stationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system wlportable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part II, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part 111. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part It. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part III).
PART II.75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required .because operation .fails one of the eligibility
requirements listed below:
F1 Lack. ofacreagewhichTesultedimovermpplicationmf-wastewater_(PAN) on:spray.
field(s) :accordingfofarm'sdastiwoyears mflrrigaiionzecords.-=
F2 Unclear, -illegible, -or lack of information/map.
✓ F3 Obvious -.Field -limitations -(numerous =djtches ;-:failure Io Aeduct:required
bufferlsetbackmcreage;-or25% _of total:acreageadentified-iri-CAWMP..:indludes
small ;-irregulady-shaped .fields --fields less than -5 acres -for travel ers-or_less-than
2 acres -for.-stationary-sprinklers).
F4 WA determination required because CAWMP credits feld(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

- - —�--Revised'April 0, 1999-'°"
Facility Number _-
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination -
TRACT I FIELD TYPE OF I TOTAL I CAWMP FIELD I COMMENTS3
NUMBER NUMBER11,2 IRRIGATION ACRES ACRES %
SYSTEM 11
6:3
o
6aq
a-r3
�Pu.ag
(,r7
Ko
�
FIELD NUMBER' - hydrant, pull, zone, or point numbers may be used in place of field numbers depending on CAWIIIP
and type of irrigation -system. If pulls, etc. cross Tnore -than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; otherwise operation will be subject to WA determination.
FIELD NUMBER2 - must be clearly delineated on map.
COMMENTS' - back-up fields with CAWMP acFeage-exceeding475% of its total:acres and having Teceived less than 509"
of its annual PAN as documented in the farms previous -two years' (11997 & 1998) of irrigation Tecorcis; cannot serve as the
sole basis -for requiring a WA Determination:-Back-upfelds-must -be noted in the comment -section and most be access'.ble
by irrigation system.
Part 1V. Pending WA Determinations -
Pi Plan -.lacks.foliowing-information:
P2 Plan revision maysatisfy75% rule based on adequate overall PAN deficit and by
adjusting all field -acreage -to below 75% use rate
P3 Other (ielin process of installing new irrigation system

-1/
Lagoon Dike Inspection Report
Name of Farm / Facility
Bert Hall (Bert
Hall Farms) 67 - 35
Location of Farm / Facility
Huffmantown Road
Owner's Name, Address
Bert Hall,1006
Longshore Drive, know Hill,
and Telephone Number
C 28580 252-747-5606
Date of Inspection
9 / 29/ 99
Names of Inspectors Zahid Khan
Vincent Loris
Structural Height, Feet
3-4
Freeboard, Feet 20-22 inches
Lagoon Surface Area, Sq. Ft.
87,050
Top Width, Feet 4-5
Upstream Slope, xH: IV
2 to_ 1
Downstream Slope, aH:ly _ 4 to I
Embankment Sliding?
Yes
_X No
( Check One, Describe if Yes )
Seepage?
Yes`
No
( Check One, Describe if Yes }
Erosion?
Yes
�X ._ No
( Check One, Describe if Yes)
Condition of
good grass
cover
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Yes
_ X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed?
Yes
X No
Engineering Study Needed?
Yes
X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X_ No
Other Comments
Talked with_
Farm Manager on Lagoon
_ _

Division of Soil and Water Conservation ❑ Other Agency
ElDivision of Water Quality
,Routine O Complaint 0 Follow-up of DWQ inspection O Follow-up of DSW C review O Other j
Date of Inspection /D
Facility Number
��....�� Time of Inspection ll : �� Ul 24 hr. (hh:mm)
E1'Registered 04tified © Applied for Permit [3 Permitted Q Not Opera Date Last Operated: ..........................
Farm Name: .......... E2 r AQ Countv: o..t� ...........................
Q�.................jji-.fl��..........._...'t.........................
Owner Name:...... ....1` �........................................................ Phone No: CR ... 1 �. -r 5.%..�5......................
.... ...............
FacilityContact: ...................................:.......................................... Title:................................................................ Phone No:...................................................
Mailing Address" ...... (..Q tP...... i............. ..a . ................ .............. ..........................
Onsite Representative:......... Integrator:.-.....�...........................................
.........�:7``�-"^.-..----•..............................................
Certified Operator;-....... �i?f`r� Lt. Operator Certification Number; .........................................
Location of Farm: � ..� !/Inl�� i�r.�rn lC ..c��iv�? �_. ,y�,�% 0„�-
L
Latitude �•.�' �" Longitude
Design -Current - Desi Current Desi Current
Swute CaAN gn gn
pacr#y'Populahon Poultry '."Capacity .Population Cattle Capactty;;Populatton
ElWean to Feeder ` El Layer ❑ Dairy
FederFinish {G '` ❑ Non -Layer JE1 Non -Dairy
❑ Farrow to Wean
n , ❑ Farrow to Feeder 410 Other e
❑Farrow to Finish ' "Total Total Design Capacity
'; ❑ Gilts x.
=s ❑Boars T6taI:SSLW
oiLagoons 1 Holding Ponds ❑ Subsurface Drains Present © Lagoon Area
❑ Spray Field Area y
dumber
❑ No Liquid Waste Management System
rf
,vt
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
�To
2. Is any discharge observed from any part of the operation?
❑ Yes
MNTo
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 aal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
Cl Yes
Eko
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
E�No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
EiNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
❑ No
7/25/97
Continued on back

l
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? Cl Yes N6QO
Structures lLa oons 11oldin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): .........' ....i.... �.....................
............... ....................I...............
l0. is seepage observed from any of the structures? ❑ Yes _Ek, 10
l L Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes tk-o
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes.
o
Waste Application
14. Is there physical evidence of over application?
❑ Yes
j;ti'o'
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ....L�t.[�. Ll�ll pin.... Y..d .{{..f�.57�.11 vrcc� � 5 eha_ . ��
. ............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Yes
❑ No-
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
ANo
18. Does the receiving crop need improvement?
❑ Yes
ON
19. Is there a lack of available waste application equipment?
❑ Yes
tlNo
20. Does facility require a follow-up visit by same agency?
❑ Yes
(6'o
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'.'
❑ Yes
IWti'o
22. Does record keeping need improvement?
Ayes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? es ❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP? ❑ Yes 01�10
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes OE6;o
0 No.violations or deficiencies.were'ntited-during this. visit. You.will receive no further
correspondence ah:out this: visit: • . - : - . -
Comments (referto question #): ;Explain any,YES answers and/or any recomrnendattons or any other comments
Use drawrngs of facthty to better.explain situations 'Oise additional Rages as;necess ry} �ME
�­ 0
jz Sys- ne-�
.
1 L ' Saw) k'.L c
W44_-,
7/25197
�:-
Reviewer/Inspector Name �! (' :� + r fi - ,
Reviewer/Inspector Signature: Date: p

N. C. DIVISION OF ENVIRONMENTAL MANAGEMENT
COMPLAINT/EMERGENCY REPORT FORM
WILMINGTON REGIONAL OFFICE
Received by: D a %I e_�Aa` s 1 vv a e-r Da to/Time: 3 1 7 1 g 1 _
Ebbezvency: Omplaint:X,_ CODUty:_- 01"-1 ID �- T
Report Received F!z7=:_
Acg+ency:
Caaiplai.nant :
Address:
Qxwlaint or Incident:
Time and Date Occurred:
Location of Area Affected:
F!P
Phone No.
Surface waters Involved: X Groundwater Involved: Other:
Other Agencies/Sections Notified:
Investigation Details:
-� c. - 1. 1--4 i 3
1nvaestigator: Date:
EPA Region IV (4040C-4062 Pesticides 733 3556 Eanergency Marra —ent 7333867 Wr7dlife Rerources 733-7291
Solid and Hazardous Waste 733-2I78 Marine Rakeries 726-702I Watw Supply Branch 733-2321 U.S. Coan Guard MSO 3434981
127 Cardinal Drive Extension, Wilmington. N.C. 28405-3845 0 Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer

DSWG:-A'iffi . ... ....
n a1-Fe'6d16t-..0P6'iation
rN
bw m niaLFeed1bt..
Operation
Routine Complaint 0 Follow-up of_DWO inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
I— Time of Inspection 34G Use 24 hr. time
Farm Status: S. Total Time (in hours) Spent onRe%riew
or Inspection (includes travel and processing)
Farm Name:
Owner Name: Phone
Mailinc, Address: Levi, s L cm Dr.
Onsite Representative: Integrator:
Certified Operator- -jj ' Operator Certification Number:
Location of Farm:
Latitude 0 & FiTl - Longitude 0 4 = I.
[13Not Operational Date Last Operated:
r}-pe of Operation and Design Capacity
Swine' Number 1U
Ni�6
11 Wean to Feeder
IUMer,
El Laver
I[ -1 Dairy
Weeder to Finish 7-0143
"i El Ion -Laver Be
-
Beef
Farrow to Wean
mom
El Farrow to Feeder
F ow to Finish
Other Ty
Type of Livestock
7'7,
Number of Lagoons l IaldiugPo>ids hew Subsurface Drains Present
I0 Lagoon Ar=ea.,---•121 Sprav Field Area L-S
�R
General
1. Are there any buffers that need maintenance/improvement? D Yes M No
2- Is any discharge observed from any part of the operation? D Yes [2 No
a- If discharge is observed, was the conveyance man-made? El Yes P'N*o
I
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) D Yes q No
C,
c. If discharge is observed, what is the estimated flow in galtmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Yes "N o
Is there evidence of past discharge from any part of the operation? El Yes No
4. Was there —,nv adverse impacts to the waters of the State other than from a discharge? D Yes No
5. Does any part of the waste management system (other than lagoons/hoiding ponds) require ❑ Yes No
mainteriancelimprovement?
Continued on back

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after I/l/97)?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Pondsl
9. Is structural freeboard less -than adequate?
Freeboard (ft): Lagoon 1 La_oon 2 Lagoon 3
Z.
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
11 Do any of the structuues lack adquate markers to identify start and stop pumping levels?
N'Vaste Anylication
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 V.,! t —L ,, ; .ti - - - _ ._. ..T ^!
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?.
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Oniv -
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal. Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did ReviewevInspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes Y No
❑ Yes P9 No
❑ Yes P No
❑ Yes PO No
Lagoon 4
❑ Yes No
❑ Yes No
❑ Yes P No
❑ Yes 0 No
❑ Yes ANo
❑ Yes FNo
❑ Yes ®No
❑ Yes Q No
❑ Yes �] No
❑ Yes No
❑ Yes Q No
❑ Yes 9 No
❑ Yes INNo
❑ Yes I'V Na
Coauneats {refer toAquestton �} Ez�ilatn any YES. answers�andlor any recommendations or any other comments > a ,�
�.'r -_ - < x.�x ...zgr .;Rn. �m'$r'�^-. -- -fr rs x^ '"�'xrb '?.'�z `+�ic�r •a,x;.-�-", ...o �'#�r�2"'"�' `, L7 f�'c�" F,s ..- a
Use drawmes'of facility to better exgla siivattons " use addivanal prages as necessary):
Y�lC11lT'1! 4CC�i5
T G_Y f w A--fl
;rc3 txf e_-"kc/,'� �s` � ab; I � �-t�e5. �r� t r���� I; (,2 s�y�,,Y4� jcl
l IJAS k.rL'bt 01 GnG C[I O�S Gc—
Reviewedinspector Name
w e
Reviwer/Inspector Signature:
-
Dale: *47
cc: Division of Water Quality, JVater Quality Section, Facility Assessment Unit 11/14,196

0
•
Site Requires Immediate Attenti 9n�: 40
Facility No. sU L=36�k
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: 1995
Time:
Farm Name/Own
Mailing Address:
County:
Integrator. uw--y fY Phone:
On Site Representative: � Phone:
SSRO
Physical Address/Location: - /9� -
Type of Operation: Swine Poultry Cattle
Design Capacity: ' 2— Number of Animals on Site:
DEM Certification Number: ACE DEM Cerufica Number: ACNEW
Latitude: Longitude: ° l J Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have ufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) es r No Actual Freeboard: —4—Ft. 6 Inches
Was any seepage observed from the lagoon(s)? Yes N Was any erosion observed? Yes r N
Is adequate land available for,,spray? / s r No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Y&51or No
100 Feet from Wells?/Yet}or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters o e state by man-made ditch, flushing system, or other
similar man-made devices? Yes LN If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, Iand applied,
spray irrigated on specific acrea e with cover crop)? Yes or No
Additional Comments: fig" '1--P4 &) �'�LY �
&-r- ! r/ M- C-1-
• Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention: try`
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 9 ^�''$ , 1995
Farm Name/Owner:
Time: ) 3 4S
1�7 1 T / P a `fir c g tree. o- F:Aa -r C DIET)
Mailing Address: b 6 Ll a
County: 6 rs f,
Integrator. �V u' ti Phone:
On Site Representative: Phone-.
Physical Address/Location: 1-7303 0 - d t,-:. Pr-o%,- 130f
Type of Operation: Swine v Poultry Cattle
Design Capacity;;21/ Number of Animals on Site: '^ -
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: .° ; ' 54 " Longitude: 17 a Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon hav ici t freeboard of 1 Foot + 25 year 24 ho storm event
(approximately 1 Foot + 7 inches) s No Actual Freeboard: �Ft. Inches
• Was any seepage observed from the lag n(s)? Yes o To Was any erosion observed? Yes or TJO
Is adequate land available for spray? s No Is the cover crop adequate. Yes r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?
Ylyi or No
100 Feet from -Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es or6
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters a state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or
(L30
'� G K � r,
Additional Comments: ' Gam/
t) 'P (Lit, (Le fz JS _
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fix : 919-715-6048 Jul 24 ' 95 18:17 P. -10118.
Site Requires Immediate Attention &o
Facility Number: 7-
SITE VISITATION RECORD
DATE: : _ 1995
.Owner: ger'f _ i 11 _ _-. Farm Name:
County:' j�2s �o w _
Arent Visiting Site: ./C Phone: / 2
Operator e 7� �� Phone: 621y
On Site Representative: 1� �� f� Phone:
Physical Address: _ /R 1Lr`s! � � �r� �' 'F /K",r _# 7,51 d L, 5'of*- 13,1 z-
Mailing Address:
Type of Operation: Swine •! Poultry _ Cattle
Design Capacity; Number of Animals on Site: Z
Latitude: " Longitude: o "
Type of Inspection: Ground ✓ Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot +$ inches) (135 or No Actual Freeboard: ^_Z__ Feet .0 Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or M Was there erosion of the dam?: Yes order
Is adequate land available for land application? Zps or No Is the cover crap adequate? Vs or No
Additional Comments:
t:ux to (1)1 ;1 71 -5-35�1) SI,-,T 'tury n( AY=