670063_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: �` Region: I
Farm Name: dQ f4l,en Owner Email:
Uj
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �0 t �t �''� -g
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: q I q U o
Certification Number:
Longitude:
9
3 I
1
Design
� aHWI,�Y
allft
Current
Design
I
Current
3��
AiqllWlll?
Design.
IN , �111
ullfl 1111l101
Current
oflW41EWj -
Swine
Capacity
Pop.
Wet Poultry
Capes acity
Pop.,
Cattle
pacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other,
Turkey Poults
Other
Other
sv�srrear.mr.a.......r3rno............ in.-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes O(No [:)NA [:]NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes §N0
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

- Eacili Number: - Date of Inspection: F
Waste Collection & Treatment IIJIIJ
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 131
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
��CC
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [XNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 'N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Neavy 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): i ., 1f1d1d1 �1"� 6 Q
Tom.
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
I,No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
IN No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UK No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Ix Yes ❑ No ❑ NA ❑ NE
,Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'PqNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �; No ❑ NA ❑ NE
Page 2 of 3 21412015 Continuer!

Fai ili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 9No ❑ 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 0
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑�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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
El Yes �No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes �(No ❑ NA ❑ NE
❑ Yes [NNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 6i No ❑ NA ❑ NE
Comments'(refer to quest�oo #): Explain any YES aoswersand/or any additional recvmmendatious orany other comments
Use drawn s of facili ta, tietter ex' Ia�n�situations„(yse'additibaal: a esas�necessa
g ty; P p g r 3')•
4W
� A-�1
vct+e� de r
r(,�rree+
cSla.�P.r�e dW "It eV14 Jb
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: t qq
Date: 1 Z v
2/4, 015

Type of Visit: &Compliance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: d Routine O Complaint O Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: rn�� County:yW Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: r }bo4L� 252- , T Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: q F �3 L�
Certification Number:
Longitude:
Design Current
Design
Current
Design
C+urrent
wine
Capacity Pop.
Wet Poultry
Capacity
Plop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C►urrent
Dry Cow
Farrow to Feeder
Drr P■ouitr,
C►_a aci
Pyo
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Poults
FI—Ot
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

dq
hacili Number: - Date of Ins ection:
Waste Collection & Treatment
4" Is storage capacity (structural plus storm storage plus heavy,rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �.1Q-="`—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme al threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application`? If yes, check the appropriate box below. ❑ Yes 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): l
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?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
D/Yes
20. Does the facilityY 1 to have all components of the CAWMP readily available? If yes, check Yes ❑ No
the appropriate ox.
joes
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Ot er: record keeping need improvement? If yes, check the appropriate box below. Yes []No
te Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
o
0
No
No
No
No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Weather Code
Sludge Survey
❑NA ❑NE
❑ NA [] NE
Page 2 of 3 21412015 Continued

1%cility Number: t I - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
1
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
E
Q Yes ONo ❑ NA VNE
[:]Yes RNo ❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes [a/No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 2(No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E24No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations fuse additional pages as necessarv).
NbvJ 00 r1EE0U Fb6z AXW YZVTr AdD NFW WWfAT uMA
WE77lPd?t.k_' Ac90 n/E690.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
__�Ic)fl 0
L
DAYS.
S,
Phone: R M
Date: S
1412 1

1 y}eC ui r 131L: V 1-URUPuttuMc 1113Yru1u1J v WPUI nuUu rcricw V • LE utiLw c c.vx1ua11un V i CL1111Mu1 ,t%bbin slut:
Reason for Visit: 0 Routine () Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t 2 Arrival Time: o Y 37Departure Time: !21 T' County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: _E(-, ^ j+'^ 0' tS Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Wean to Finish
r[ Swine
Design
Capacity
C►urrent
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
i;.0 0
4 4400
Design Current
Dr. P,oultr. Ca aci P,o P.
Lavers
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layer
Boars
Puliets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes EXNo
❑ NA ❑ NE
[]Yes ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facilfty Number: - Date of Inspection: 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 06 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[:]No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
trYes
❑ No
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�5`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
[ o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or im rovement9
p
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ENo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 6i o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes WNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
I& Is there a lack of properly operating waste application equipment?
❑ Yes ff No ❑ NA ❑ NE
❑ Yes a/No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
[:3 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes 2yNo
❑ 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 E3"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ��;No,❑
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

'4Facilit!r Number: jDate of Inspection: Z .S-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3'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 eNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 1!fNA ❑ 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No
[:]Yes dNo
❑ Yes [t/No
❑ Yes E► No
❑ Yes l j No
❑ Yes dNo
❑ Yes [E]/No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other:comments.
Use drawinss of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 77 C 720
Date: zV_
21412014

Type of Visit: 0 7Routine
pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint 0 Follow-up 0 Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time: County: dNs l4/
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: poNLLTK'- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Certification Number: q q J `-r
Certification Number:
Longitude:
Wean to Finish
I I I Layer I
Daia Cow
Wean to Feeder
In iNon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D ny Po u I t nyty
Layers
Daia Heifer
Dry Cow
i-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
YNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
VNo
CDNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number: -to 5 Date of Inspection:
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 ]j Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZL
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen5dl threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes Z] N
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 17No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
/No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes N
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes yl�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
N
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 o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Othe .
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes o ❑ A ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes VNo
o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes VNo
❑ 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 ❑ 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
YNNo
❑NA
❑ NA
/No ❑ NA
FNo
❑ NA
❑ NA
❑ NA
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
SLl1 D �-C SURIIC i' ��� fin/ 30 .rAi S.
3D
Reviewer/Inspector Name:
r�
M
Phone:/ l+
❑ NE
❑ NE
❑ NE
❑ NE
❑NE
❑ NE
9 3g
Reviewer/Inspector Signature:
Date: 7'
Page 3 of 3 1 21417PH

(Type of Visit: 0 Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: p pXS(_6 0 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: DNS (?a&G.9. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: _ 9 9g37.6
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle C►►apacity Pop.
Daig Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Design Current
P.
Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113cef Brood Cow
Other
Other
Turke s
Turkey Poults
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes
❑ o ❑ NA ❑ NE
❑ YesVNo
❑ NA ❑ NE
[] Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: IDatC of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA GiocoJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 16 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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 21/Nlo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ZNo
❑ 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 ZN
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Oth :
21. Does record keeping need improvement? If yes, check a appropriate box below. Wes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections J4 Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Y ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes rNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Ins ection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [(No ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes YNo ❑ 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 2No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[D/No
❑ NA
❑ NE
❑ Yes
[ <o
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
2<0
❑ NA
❑ NE
❑ Yes
E2 o
❑ NA
[:]Yes
Fa/Nc ,
❑ NA
❑ Yes
a<o
❑ NA
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to Fetter explain situations (use additional pages as necessary).
) c taa_lUG �i.us ')AOK- tjCCD So �3� EKED,
a t �19A=10 Ll _ 11050C C,Tf-0v'3 ?c<�>-
❑ NE
❑ NE
❑ NE
(��Gt �A � � 1, (►�-5 rA s 1 � ,4 ��- SAS, ' Se Ja ME
�OCL (0o DA'es S (-_sc0VLC-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
AN r) *'-T-cf"
Phon4. "'J )1c (� 3
Date: % 1 S `
214,12011

i
Type of Visit: UCoryipliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: VA Z,tl Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: DD>v+L%XC FZG CI Integrator:
Phone:
Certified Operator: Certification Number: 9 9 y-; 110
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine C►►opacity Pop.
Wean to Finish
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
=INon-Layer
Dai Calf
Feeder to Finish
Y Farrow to Wean
Design
Ca aci
Current
Po
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Feeder
Farrow to Finish
Dr, P,oult ,
Layers
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C1 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L"J 1V
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
LJ 1"0
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �NoO ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env"mental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes [] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes &No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�No ❑ NA 0 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 D/N o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
eTNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
6No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
13 0
❑ NA
❑ NE
Required Records & Documents
�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EJ 1`'
❑ NA
[3 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�J lac
❑ 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 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
E/o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of inspection; 2
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 L No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ 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 O/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
• permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 10 .
❑ Yes No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
FNo
No ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to better explain situations (use additional pages as necessary).
c7. ';�Zzm
bM HOUS E
i To LAC"J N As 14 OLrt
,
ADP K C, s s
Ia a..7 A zW
3 d oR \s, worn F`� D w O
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: WIZ,
21412011

Dw�s�on of Wsilter ualtt_
a $ - I-. E t Qr, Y.
- + 6�Y 1 i -� ,,�; filar 1.
Fad ity,Numbeir (y,�j Q Dtvts�oit of Sml and(Water Conservation
D Other A enc _ t +a �IM'u
g y t,
L
f Visit Wcom liance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit VRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Eq;0 Arrival Time: Departure Time: County: 6tJ5L,6b.J Region:
Farm Name: Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:,,) c r`aNSL— ��-GGS Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = ` = 11 Longitude: = o
Design Current 'Design. Current f ,Design;' Current
a i, , t; a,ast bl i -
- m ri
Swine I= y Capacity E'c,piilation• xWetkl'oultryx Cap�cityi Populations := Cattle ,��oWh�i, h Capacity Population a
❑
Wean to Finish
❑
Wean to Feeder
EZ
Feeder to Finish
19
❑
Farrow to Wean
❑
Farrow to Feeder
ElFarrow
to Finish
❑
Gilts
❑
Boars
C
ILJ Non -Layer
Dry:Poultry
Other
kk yy �
Other
.p-
.
El Dairy Cow
El Dairy Calf
El Dairy Heifer
ElD Cow
❑ Non-Dai
[I Beef Stocker
El Beef Feeder
El Beef Brood Cow
r& Num
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 No ❑ NA FINE
❑ Yes
r& Num
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 No ❑ NA FINE
❑ Yes
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 No ❑ NA FINE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El❑ NA
ElNE
❑ Yes
❑ Yes
L� N ❑ NA
ElNE
ElYes
o ❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection ' i
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 t Structure 2 Structure 3 Structure 4
Identifier: "60V+A) 1
❑ Yes O/No ❑ NA ❑ NE
❑Yes ❑No ID NA El NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 15Lf
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2f No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E tvo
❑ 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
El Yes
,,�
'7J No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
'7"'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,VNo
NN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
,E
L,d'No
❑ NA
❑ NE
Comments (refer to question""#) i zplain "any YES ansWe-is and/or any recom`mendatinris ur;any other com' menu{ _ � a ,"
Use drawings of facility to better explain situations `(use additional pages as necessary): 'I
`I,�Tie.1► ff�R-- l�t�tE GoZ+JG YV 31kO LAGovh, HAS A&ALA- LeAitr. PLEAS6 A0V#LeS • Af $�E
pQE�llo�Slr1' �ATG!-1t�4. ~CRAr�.T�rrfl� l�Ni �ito►nti OLD MJt<14h� �lotl,fF 4;� i-loLre Z t.L�JF AS
ac,4,N CAPFC0 a F F
-% d1ViF rq'p st uvc c 4' PiQ✓c o�,& V*JL U,64rki 30A
.
,y ,,LE9
Reviewer/Inspector Name,-,tt,'_�`�..6.x 41a�t��Fn�.-, k" Phone
Reviewer/Inspector Signature: Date: �] j
Page 2 of 3 1
12128104 Continued

[Facility Number: — �3 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 CAWM P readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes Z No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C�NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
dyes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
El No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes ld o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal`?
IJ
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes El NA El NE
No
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes dNo
El NA
[I 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

IF
b
Type of Visit d C mpliance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 + I'u Arrival Time: 4f 50 Departure Time: County: W Si6�J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative:Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 c = �" Longitude: = ° =' = "
FD Current
Design Current Design C•unrent
Swine Capacity Pnpulation
Wet Poultry Capacity Population Cattle C►apacity Population
Wean to Finish
❑ La er
❑ DairyCow
EWean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
4 Ict
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
El Layers
❑ Beef Stacker
❑ Gilts
El Non- Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other.
❑ Turkey Poults
❑ Other Number of Structures:
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ["No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
WN o
❑ NA
❑ NE
❑ Yes
[13/No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: c-iaXIOCVl
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3rj
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 EZ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes jNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ElNA [INE
2
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1:3 No ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes 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
o
❑ NA
ElNE
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 acre determination ?
❑ Yes
�/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
do
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
"Comments (refer twquestion #) s .pExplam.any YES answers and/or any recommendations or.4j.
n other comments ' a
�. & a.fitki..:i"9� VAA t ix.y k eti $ ;' ..
Use drawings; of facil fy to better explainasituatlimis['., use;addit1onal p``age55s=[[as }}necessary) r 1 "���p � �[y 1 g � t °„
�l i'ss �Z:1_.i 1n'i LY��i-s3R.t%. vs
ay.�asJ Gay GoPy SWC)G-E, CAL-r0aATEo3 P"rv, S op k)
•
Reviewer/Inspector Name �� `� Phone: QI
Reviewer/Inspector Signature: Date:
Page 2 of 3 1 12128104 Continued

J
Facility Number: r�` r — Date of Inspection tZ.
' 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
El Yes 4 ElNA ElNE
❑ Yes �/No ❑ NA ❑ NE
❑ 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 I" Rain Inspections ❑ Weather Code
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 IJ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? Wyzyes
es
ElNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes F,, rN ,o ElNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElYes ld No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
12No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PrNo
❑ 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
ZN
❑ 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
CYNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
<o
❑ NA
❑ NE
Additional Comments and/or Drawings -
'A
Page 3 of 3 12128104
Page 3 of 3 12128104

3
Type of Visit 9"Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ipi J 1 Arrival Time: Departure Time: County: Q./ysir0' Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Don , r-< Rah GS
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = i = Longitude: = o
Swine
r
Design Current
Capacity Poprolation
Design Current
Wet Poultry Gapcity Population
Design Current
Cattle Capacity Population
t Fini h ❑
Wean o s
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
® Feeder to Finish g 24M
❑ Dairy.Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
jNo
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
[]NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there an adverse impacts or potential adverse impacts to the Waters of the State
Y p
❑ Yes
Zo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection O
V aste 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: CA W
Spillway?:
Designed Freeboard (in): nn
Observed Freeboard (in): d5
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No El NA El NE
ElEN Yes o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thl eat, notify DWQ
T Do any of the structures need maintenance or improvement? ❑ Yes J_[J(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [21No ❑ 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes UJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ICJ 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
E No
❑ NA
❑ NE
/No
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
L'1 No
❑ NA
❑ NI-
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
�(No
❑ NA
❑ NE
Comments (refer to£question!#} Explain any YES +answersandlor any+ recommendations or°any
Use drawings-o'f facility�to bettcraexp[ain,s tiiations. (use. addittonttl page,S as¢;n$etessary):'}
othericomments.i
t T i a1
�YF-''
5(J"£ kX P4- *3 00A
sT�L` ►.� t� 1L ARaLo 9 "�-ovJS��iit✓ Ps p ' Lis E
ck r✓ G>K ,
Reviewer/Inspector Name o
Phone: 9` ` 3
Reviewer/inspector Signature:
Date: 9/1 -7 O
Page 2 of 3 1 12128104 Continued

Facility Number: — 3 Date of inspection n
Ri ciuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [/ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ElYes
ZNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
LJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
I;'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
E Yes
❑�No
❑ NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
�J No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L2`No
❑ NA
❑ NE
Other Issues �
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El,.,
Yes � No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L'7 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?
ElR Yes
�/
E 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
Q 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
El No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E4o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 C
opliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: zi Ol Arrival Time: 0 Jt5 Departure Time: County: 0414►.J Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: too Aw-.r s - Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ l = f4 Longitude: ❑ o = 6 0 H
Design Current
n' Design
SwineCap�ac ty Populaton
Wet Poultry Gapaclty PopuatC•apa�city
Population
❑ Wean to Finish
❑ La er
r�CIDCow
❑ Wean to Feeder
❑ Non -La er
Calf
® Feeder to Finish
�Q7f
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
Non -La ersEl
❑Beef Feeder
PCGilts
Boars
Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Pouits
❑ Other
❑ Other
Number of Structures:
Discharges & 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Iracility Number: — Date of Inspection 0
Waste Collection & Treatment
4— Forage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ZNo
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ NA ❑ NE.
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltreat, notify DWQ
`? El7. Do any of the structures need maintenance or improvementYes Zo
o El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ['/yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA [__1 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I. No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
Cl Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo ❑ NA
❑ NE
lo [INA
❑ NE
Vo ❑ NA
❑ NE
❑NA
El NE
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i11ANS�60- ItNJt 1'!' A P00 5X6vti K-, R A SOV I -AWL Q" 0l
Reviewer/Inspector Name b Phone: q%D /91; r
Reviewer/Inspector Signature: Date: a<
12128104 Continued

Facility Number: = Date of Inspection
&quired 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 ❑ Checklists ❑ Design El Mans El Other
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
.!U N
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
eNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El"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?
El Yes
��/
�I No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Ll No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
g . :i4� 4 C �" kt� "
AdditionaLComri>ents'gnd/or Drawin s t �4 <x
'k s6
Y.
a'$8i y� ,�4` �:�{ F tY� ea9 a
fi ;•
w
Page 3 of 3 12128104

ty
Division of Water Quali
Facility Number �� i {0 3 Q.'Division of Soil and Water Conservation
Q :Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 44outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 2�rs to,Arrival Time: Departure Time: County: d&WSisi,% Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: rAA)4KL%t0 ZzGCGS Integrator•
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ 6 0 N Longitude: 0 ° = 1 = "
,r
Design Current, ? Design',. Current ��1)esign Current ,
Swme. Capacity Population: Wet Poultry Capacity Plopulatton Cattle R Capacity PopulatJon-'_
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish
4tlq 9
L4
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer f
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
[--]Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
k
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)?
Number of Structures..
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes JNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
El Yes
❑No
❑ Yes
�
❑ NA
❑ NE
El Yes
WNo
❑NA
❑NE
12128104 Continued

Facility Number: 4 — Date of Inspection z ,a
Waste Collection & Treatment ,,{
4." Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes E 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: LA 6001")
Spillway?:
Designed Freeboard (in): 2a
Observed Freeboard (in): qX0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,{
6. Are there structures on -site which are not properly addressed and/or managed El 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 No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes LJ 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 CNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
EfNo
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�jNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
31kASC i]o CALr59-4TXa+J -* SuUpGE 5Q(LVC`{ W.STNZri
30 rJA%JS AND SEND tow
-
Ta OW a
o
W�1a AA'. Ur.� �POAi'Eb
Reviewer/Inspector Name _ rA R --.__ - -
— I Phone:
Reviewer/inspector Signature: Q4. IWAV
Date: Zj13lo�
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection dl
r
# egulred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. e8 L7No ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes E No ❑ NA ❑ NE
❑ Yes EJ/No ❑ NA ❑ NE
❑ Yes
[,:?No
❑ NA
❑ NE
❑ Yes
Q**No
❑ NA
❑ NE
1201yes
❑ No
❑ NA
❑ NE
2/yes
❑ No
❑ NA
❑ NE
❑ Yes
E�rNo
❑ NA
El NE
El Yes
i k o
❑ NA
❑ NE
❑ Yes �?No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes LI No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
Page 3 of 3 12128104

h W Division of Water Quality
c� Facility Number : (i'j �p Q Division of Soil and Water Conservation
Q-Other Agency:
Type of Visit 6 Co liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: IV Arrival Time: d0 Departure Time: County: 0AZL612 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �j Title:
OnsiteRepresentative: FR-IatJh-it"�1� 1�.�(>CYS
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: 0 ° =
Design Current..
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish L! lei Y
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
Design: Current
Wet Poultry Capacity. Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
I
I
i
Design Current`
Cattle -:Capacity. Population'`
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures .>
Discharges & Stream Impacts
1. Is. any discharge observed from any part of the operation?
❑ Yes
2/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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
yNo
❑ 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?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection 11 oi;
i 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 Structure 2 Structure 3/ Structure 4
Identifier: (A �N
Spillway?:
Designed Freeboard (in): ' 2A
Observed Freeboard (in): (Y' a
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 YJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Cf� [INA [INE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes � El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El❑ Yes LI N NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑
9. Does any part of the waste management system other than the waste structures require ❑ Yes No El NA El NE
maintenance or improvement?
Waste Application ..�,/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No
❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
V ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
u No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L2'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 other comments.
Use drawings. of facility to better explain situations.,(use additional. pages as necessary):
A- a rd Ao AoVMVAI✓ C-EIZrZr. (A rJ
.Z•7) Arc6 1-0 Op (-A Lr�aA T�Iov.
1W
ReviewerllnspectorName I ��� h! l�1laQ-lJLi.L: Phone: �'/b--7oZipr
Reviewer/inspector Signature: 922ft. Date: 0 S_
Page 2 of 3 12128104 Continued

Facility Number: 7 — Date of Inspection u
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dN ❑ 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 El Maps El Other ,,,,��//
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes @!;?Annual
El NA El NE
[I Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers 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
0No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Y
L1 No
[I NA
[I NE
24.
Did the Facility fail to calibrate waste application equipment as required by the permit?
Yes
❑ N
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
L No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
7NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ld No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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?
ElLI 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
Q'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 and/or Drawings:
Page 3 of 3 12128104

Type of Visit QCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit C4outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �jSL(% _ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: L7ooiv ((- QugTz�j, .� integrator:
Certified Operator -
Back -up Operator:
Location of Farm:
I Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Boars
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c =1 Longitude: 0 ° =1 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
^ ❑ Non -La ei
Other
❑ Other. -
Dry Poultry
❑ Layers
❑ Non -Layers j
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
Discharges & Stream lmoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
h. Did the discharge reach waters ofthe State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Cl No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[,fo
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
12128104 Continued

Facility Number: — 63 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes YNo ❑ 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: (_,96-2o,) I woL,=tjC _L V).L0 V)& Z an:.,nr-i La
Spillway?:
Designed Freeboard (in): 710
Observed Freeboard (in): .3S
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 dNo ❑ 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 Zo
N ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No. ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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) gtax^ �P1 1'4 USW
13. Soil type(s) BOO T1b
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'E] No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0'/No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
info ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2/h ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ld No ❑ NA
❑ NE
Ncg_-_t> so 0o er-09 �rE1~os, 01137rA=J -?,az,,J GAvc7<.. nua R.w(LD R.AMPFALL,
awri &I k&Tq -IF FJ,Ek.s�-- VJA-U -. j resEb p COPY a( A NNvAL Cf T
-
ay) rno T Cak_:LGaAWT� PQ1A(VX0is EQv39w,cNr `ti` f v1jO�rL 0i� t�C_0_6,Z r.
rA1J5 1� AN►S+IAi STau;-WG- Vaom VJTG6ti-A t41L 0PT=k,'jj{6kJ rye, 5 ckzo6. "
Reviewer/Inspector Name " `,v `
Ul-1vJ iAtL1.�F=t..l �Phone: NO34S-3gno 42P3
Reviewer/inspector Signature: Date: 2A i'a S,
12128104 Continued

r
,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 appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes
;/N0
❑ NA
❑ NE
El Yes
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Applic on ❑ We kly Freeboard ❑ Waste Analysis ❑ SoillAA alysis ❑ Waste Transfers D Annual Certification
IQ Rainfall Stocking Crop Yield ❑ 120 Minute Inspections L� Monthly and l" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? dyes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ffNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? l/J Yes❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,G3 No ❑ NA El NE
26. Did the facility fail to have an actively certified operator in charge? ElId Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No E;KNA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EXio ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ErNo
❑ 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?
El Yes
,�
L"J 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
B"Ro
❑ 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
B<o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No-
❑ NA
❑ NE
Additional Comments and/or Drawings:
t FM �.5 �A •N
12128104
12128104

S
[Type of Visit 0 Compliance Inspection_ • O Operation Review O Lagoon Evaluation
Reason for Visit 9T Routine O Complaint Q Follow up O Emergency {notification O Other
Facility Number Date of Visit:
Permitted © Ce ' ed D Coo''tionally Ce ' ied ©Re 'stered
Farm Name:.......................... r l..1.L/. ... t�6..... .....
Owner Name: ...............�YG/ ..........�................................
Not
❑ Denied Access l—
ional O Below
Date Last Operated Above Threshold : .........................
County:....... /`..arc .............................................
Phone No:
MailingAddress:................................................................. ................................................... ....................................................................... ........ ..........................
Facility Contact: ........................ _ am.........'.... . Title:......................... .................. P onNo:
..o:...................................................
......................Integrator:...............................................Onsite Representative :✓ffGL......../
Certified Operator:
Location of Farm:
Operator Certification Number:...... ....................................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' ���
ITN;" ik;h3};i ss -.:; ti ;, 3 - �. 4 a. ea E , ei' a E.. .�;.., ,�,
e .l ' £ ' DeSlgn +1 !� Ct_lr1 gilt ifi' :' .r, t > 3�' i ' r sil u° Design yt CUrr@IIt
i Desi : orient, ii'i , +' 'i
Swine = i ,
} "Ca aCl PO Ulatlon FtPQ1ilt1C3 ++: �_Ca SCi P. Ulatlon.' , t C+att 6 t `t ._.E i .Ca $CE , s:"PEi uiaaoI�i,i
.Jtl ❑ Wean to Feederi ❑Layer EON
❑ Feeder to Finish ❑ Non Layer Dauy:; i,.- ...... i W;.' tS a :E fi'
a❑ Farrow to Wean'
❑ Oder li 31 1 Ei 11g,� 1 4;,;�Jitrt-
�� t i a f" il S iY ��� g cr I t+ 1+
❑ Farrow to Feeder
4 �F r } ,..,.-.'
.
Farrow t0 Finish
?, ❑ Gilts i ii}, jeEa.' �r �( �3� �� �.......
(3x� C is
❑Boars } >` i�a ; ' a otal SSL W
iSa
'F�+, l� tt, r: it y , & �Ii' a h, F' i dti.! '� t.1} ''' ta''ij i p E•, '
a� `Number of L_ _agoons,� ;
1e r h 11 ' 4 }yl t i s c E i7i i e t i 1
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other j
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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;dNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
cture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
,truIdentifier: .. 4&............ .......................- ..................................
3........................................................................................................
Freeboard (inches):
12112103 Continued

tY Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes 0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes 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 ;� No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes j2f No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes No
❑ Excessive Po mg ❑ PAN ❑ H draulic Overload ❑ Frozen Ground ❑ Co per and/or Zinc
12. Crop type �Q/✓
13. Do the receiving crops differ with those designated in the Certified Animal W to Management Plan (CAWMP)?
❑ Yes No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes /No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes A No
Odor 1msues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ONO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ZNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [:]Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
lq9 'l
Reviewer/Inspector Name 4 ,i
Reviewer/Inspector Signature:
as Fnecessaryi;w❑ Field Copy ❑ Final Notes
=:, 7nr
Date:
12112103 Continued

Facility Number: Date of Inspection D
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? $Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) '0 Yes ❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 11 No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ZTNo
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
�No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
91)
AA!�4c_) &47g ?r,
5� WFE vas GrJllo
AV
rv+ 8 /
12112103

i
Facility Number state of Visit: i�-"-E—� 'Time: I%
Not O erational Q Below Threshold
Permitted ® Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: �-4G's D✓Je- hirat —Lip : County:
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: t-- -'x^
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator•Qn,F1� _
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 Du Longitude a �• ��
Desigon :. E Current Desi w Current; Design Current
E y_ r. _ _� 1.�3� I' EE, :i. _ ,� i `�i f t P 11
Swine-, ;Ca activ:'°..Po alation E,, t,,Pon try*,,, Ca aci Po ulittion �E Celtic, �. = n� l.Ca"atcity 40 slatton E`
❑ Wean to Feeder 10 Layer �" ❑ Dairy
r;li i
❑ Feeder to Finish 10 Non -La er I Non Dairy
❑ Farrow to Wean «, ,
❑ Farrow to Feeder ❑Other l �a
Farrow to Finish Tt fal Design kelt
60;y
❑ Gilts j..
❑ Boars T0tal'SSLW i
Number„❑Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area s
Eloldin Ponds I;Soltd',Tra s� E ;i� 'E `
g, , p 1 Ei,--� ❑ No Liquid Waste Management System
Discharges & Strkam 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 ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

A 4
Facility Number: 6-7 — 0 Date of Inspection ;� Z
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? El 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 maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [--]No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reguired
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?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ 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 applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
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
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commeats efe„r toqueistio_n,#) Explal an,ys. YES ansv6i,and/or.a.ny recommendatons or,any_o_thema a . . €
Ue drawngsofaily ta'better explan situatioat (use additionalpagField Cony Final N1 ostes },
�
- s ,(.,r, ,
l/fi�y L me 4- P14 k,'A 9 e— Dena✓ — rla vhkn Kiy 7S� /ri5 ,j0/? //Oho; c
&P ,Awtl; s -Arom EnW 2 v11 ks beeiAse W
�.+Q ile}►� �h. �� v�COi!?r'h 1 �p/Ck47� 7���/ �JP�'G lb0/C%h5 �o/ ( T�N2�6�''�(l��
Sri t'4crt 0/t 40 [.ek �C�,G a h /( JOIk h h Pr/C Opt J4Orr�?�tha*t �V
r
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ZAP
05103101 � 0 Continued

Facility Number: 7 — 3 Date of Inspectimi ;� Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes . ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
AdditionalCommentsand/or, Drawings:, E
-A& )f b )ern i n -Aa peo✓ -Pufi jet, . 70
rya
A
n L.0.�ODn Ltnn� ��r�� ` t l►+dt �i.�ODh T
j01�Ot.
ik tSkk
WAe)i Wa'k;til 4e- ir✓est, kle, also k
�pvh � 4 o7>rte✓ .asLa� Lvgl✓� O��✓ 101�� W�tier — 3 / o�kh
or draih P/m Prbba.jly 0,01,0
.C•o,A �coan i an� Zo�nDon3�
dAe, 40th oai� 3 lear.�s �o fll6-f�ca�l hole
r
(� ✓ iDond '#- �cu5 k 1,% L Q o Above
ei Led, Ta a drAAt 1 t [goon I
y
I%�. �� �n t �✓s -fro onsii'�� � �tv�m,p
1
t���f
lGten �i �t°� a 5AVAC, 61e Clay 74Z aQ LtSGi� 'fir
d"' eJ 1'& ei'f fit.
�fx YnG 1MA S 11 Jr 1I D J ,I I
'I/ B e 1.�11"Vil a I(%l��I 4'f� AoT A4 "��tC C ►�0�lP�it g. 1�'
�cfesn lvc
+ 5�E--� /G [[li��� �[ �5 D ,bG 6vE� �►l i ��` � lNi�isl iitc>�'DNf.
&7 d
,�}� /1� � �' � � a/f e Ho ',�`tr(�` /, 7Ghn k✓✓,'�uh Qh5 't4. et a4
D T31— 05-1 &f SZ7S
05103101

Y11€Ft u ry .yt'° i8 i�nc 0alsionorwater Qualty w a
;
$tt�;+i�%'lViSliQl€Or�O�atldiBtCrCOnSelliatiOn
aFt4;s§'al } -i i. >s3at ytatr €€€tic#4 i E4{ iE�ll
m
. , € •',.- c - ff ; � , „ �. , i, a c 1, s °'- r E v ti' i }Fig � €, a ?-'..s�
Type of Visit RrCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Vkit:
O Permitted ©Certified fD Conditionally Certified [3 Registered
Farm Name: 9" �1 S 0 Oak ��t ✓-15, -
Owner Name: +' a 11Wj
Mailing Address:
Facility Contact: Title:
Onsite Representative: V,,A''t k Va'i n'a R,ej45
Wj
Certified Operator:
Location of Farm:
Z 2 0 Ti me: 3 3d
=Not Below Threshold
Date Last Operated or Above Threshold:
County: _.Onslaw _
Phone No:
Phone No:
Integrator: Snot c eh�e _
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude Longitude
Design " Current - i esign Current "` Design t ..i, Current t
:Swine, Capacity Po ulatton € „Podltry ' ' €'Ca acity: , Po ulation� `Chttle Ca `scih Population F i
❑ Wean to Feeder' ❑ Layer ❑ Dai 4
❑ Feeder to Finish ❑Non -La -Layer ❑ ❑Non -Dairy i
Farrow to Wean n> •.a,.
❑ Farrow to Feeder l ,�,. ❑ Othet
❑ Farrow to Finishs,,.�
r Total Design Capacity € F
Gilts ' ` ",i€ t) S$L
❑ Boars 'fir 4r s€ , .E s€ € a�1' tai� W.'s:
„€ Holdtn .. Ponds /'Solid Tra s « i g , p
i
❑ Subsurface Drains Present 110 La oon Area
❑ S ray Field Area i €
❑ No Liquid Waste Management S stem
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ZYes ❑ No
Discharge originated at: Zagoon ❑ 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 ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 2rNo
Structure] Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Freeboard (inches):
05103101 Continued

rFacility Number: 7 Date of Inspection 2 Z
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
El Yes 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?
XYes ❑ 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
ONO
elevation markings?
❑ Yes
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes .❑ No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes �No
12. Crop type GQr r W h P��, So y �7ea�►>< Ud a �a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ZfNo
b) Does the facility need a wettable acre determination?
❑ Yes Z] No
c) This facility is pended for a wettable acre determination?
❑ Yes No
15. Does the receiving crop need improvement?
❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes ZNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes )2rNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ No
(ie/ WUP, checklists, design, maps, etc.)
.1Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard; waste analysis & soil sample reports)
9Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes �0 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ❑ No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ,'No
24. Does facility require a follow-up visit by same agency?
Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
9Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
!. I}.�.. i. .. {. •_ F 6 d6. 3 9 -_: �rl: •[,... °t I, ":i, _ � �I, ,j •!�� E��{.;, i i�i j -_6i4i �3 F �! -�!
T.
ii ° rl : nd or,anvauther,cbroments;
Comments (refer toguestion.#) £xpiain any YES answers and/or any recotnmendat,ons
' i1 i 456. �;
,. f., . , , �:.�.W....4.,....o."4i...P>;wa w .........a..•i .•c�.Ra{,„si.i,. �
Use drawtugs of facility to isetter explam sttnattons:;(use addlttatlal+pagesfas necessary) ��' F �� Field Conv ❑ Final Notes
3 tt
i 'i6v^ . .f �" r � • - f • .. .,.. ._... ER. 'Y> �11 �: . Ye'1..:. '. -]i•.�19f >fx��&.I•f �".i .._ 33 �xnW..-+n.+i++.�l�...q�.;y.....a... _-r.7.+.e!+.•t�.�n'...
'��F �Y`G�(;a►-.� Wcisle
Wqi� /wwas{e �: s'CLux� pc� .naa sv�f�re wa �tS �+7
1 SaD a11on� ; s the es�; �� el'
W[�-tG✓ J- -}OJD� /'G��J/eS�n�gT ivPS TO Is-rVe l7vDt'FC. ile4;re 7T,4r0v1�1CA
�r�6osr►�►n►l��� 4rt-1 a41 hDf:F�,'eq`ife" t /e t�!/r e4s, /f,-. C'en�S �}ct!
•: I (Igoe rJ I q vl
' �..�".S."� it 'IYY` 'i tY[� 31 if
Reviewer/Inspector Name # �; J 7 4 ✓tiE� acT�71 ;' 4 ,•I f E cs,�}ti E .' f, ,•�,, �, s ;:.�
Reviewer/Inspector Signature: Date: JZ Z
05103101 Continued

•
Facility Number: — 3 Date of Inspection
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i,c. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes E!rNo
❑ Yes -10N0
❑ Yes ❑ No
❑ Ye��10
❑ Yes JZNo
❑ Yes ❑ No
Additional Comments. andlor'Drawings:, ;.
(�c►rpj W i�L, �j.2[� .�o.'i 4 G✓aJ2ol �;��.��C CAMnO 0v4 Yo 4RSS�'s� rahOi
l�bScr'Vt'. fl✓. i"neA "Nklcs 6►'+Ld��ct
�a cv•h� evt� �o.�drraw �o �e,�e�al° 0 rJgy, �4 ,�r",�v{T�e>�P
,, PAIPMn,'e 9;C. �s .s�„d h� d:,A nab
�,,/1171y sa.;d he had G1 � e~d v� fie / y0e wl,44 P*+.ry►C
�edl rf G1 �D' G3Yd 1'! td .S#;.1ce �Or9&-kepi G]bovr� ��. Fe42, M,-.
SR;d[ �ka-� 3�p� did rlo�<now a6nr�tf `�hp Pse.�� ,4,:s C�iR*���.
��e� �e•^-tS .
rS r �twre L oo p a(Ps; � d n G,� ten- o�tt ; aY, is r,C'ed Cd 61,7 /'q �"'X .
nLi LV q s4c:!, gYLotlyc�"j Ava�'�ab1P %Za} Gets
7 C -J3 -ZODZ. i,n✓ti�Apal', ✓Ekqe Ale. p ;'artfs
del�''i�gf Sar.� s.�ry�/�. 7�1i,'s I,jQ°�r �v� �s nr} .S✓/� r
A ISO, -tic c7-ar-,T /-)I l C1L, GYo r w l- �4 Ac i(-
r
6e.)Yeel and -ri li4-0 C N 7ec 4 4P be ��;pq��04 awl
- lac P Z %orests . v / he F;e)
1� a d
Z 5 ,��ef�r,cP : rl?� e�''��s s4r r �OY S ;s r bv� 44C
t,,i�r�e �olarn lilTs �L�1� .5
05103101

EDIvis1o11:Q1tiSotl,and. E,t WaterCOrlSCirVattOf Ei i E . ! n t r} t -'t t l f I Et i i- fI
r. i l" a- ` `,V' n f sE' ' € € f; f 'E ! ' pia: f 4.� a f i 3 i s;�• 3'� €� - �.
L
f Visit Compliance Inspection O Operation Review O Lagoon Evaluation
for'Visit *Routine Q Complaint O Follow up O Emergency Notification O Other p Denied Access
Facility Number Date of Visit: � Time: C) 134 1 Printed on: 10/26/2000
Q Not Operational Q Below Threshold
*Permitted [3 Certified J3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold
Farm Name:.....,�15�-....��............................................................................ County: . Ci k..r
..............................................................
1
OwnerName:.............................................................................................................. Phone No:.......................................................................................
Facility Contact:...............................................................................Title:..........................
MailingAddress: ............................................................................ .........................................
Onsite Representative: ... ...G!^!-�\ ......... aye,
CertifiedOperator:............................................................................... ............
Location of Farm:
.......................... Phone No:....................................
...................................��..........(........................................ ..........................
Intcgrator:......Szf. ...Q
Operator Certification Number :..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse ' Latitude 0 ' « Longitude • =1 «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE3 Layer PE3
Dairy
❑ Feeder to Finish ❑ Non -Layer Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
Farrow to Finish CG 0 Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact~
1. Is any discharge observed from any part of the operation'?
❑ Yes
Jam! No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is ohserved, 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 galhTlin?
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
NrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
M No
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XNo
Structure 1 SIruc:turc 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ...,.. .....................................................................................................................................
.........
Freeboard (inches): eor7o
5100 r
Continued
on back

.y
Facility Number: _ 63 Date of inspection C� 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 ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Cl Yes XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? WYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes NONo
Waste application
10. Are there any buffers that need maintenance/improvement? ❑ Yes jXNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ;qNo
12. Crop type e—j Uj i Sc I �C."1Mt—.� •I�t^, f
13, Do the receiving crops r differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes tKNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
WNo
b) Does the facility need a wettable acre determination?
❑ Yes
IgNo
c) This facility is pended for a wettable acre determination?
❑ Yes
21 No
15.
Does the receiving crop need improvement?
❑ Yes
N(No _
16.
is there a lack of adequate waste application equipment?
❑ Yes
No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
XYes
❑ No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
RYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
�(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application) ❑ Yes J<No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes 4No
24. Does facility require a follow-up visit by same agency? ❑ Yes CgNo
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RNo
-*h aiidris'or doficiertcies •were'toted- during Ojs'visit! 1'o r will reetriye rio further
corres• oridence: about: this visit
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
IX
� h t-e_ i ►�cG�-�r
t 4�_J Eder
VQt., lG�cc►t ck.� s� `-� Grp �G� �r.i1� (1�l 1
Reviewer/Inspector Name yam\ e
Reviewer/Inspector Signature: Date: 5100

Facility Number: Date of Inspection -_--'� 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 Ayes ❑ 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 f No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �TNo
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 ;t6No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? []Yes 15�No
itiona ommen an or
5Q( A'P-- "le,
� 1
g C�� . 1 ��1'� ���5 t ►-� 1,�1G�� �1�-� r YCi t.., �1-c � c.� C�-.T�t�1
��'i 'to�►� -�c— 4
t (Af
S y U tom. ` c��-�� r}Le?�l �i`��-�• +� ilk ��
IL .J
Y
5100

g(Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit Xcompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit t(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: ^'}�—G� 'fling: Printed on: 7/21/2000
Q Not O erational Q Below Threshold
Permitted 0 Certified l7 Conditionally Certified 0 Registered Date bast Operated or Above Threshold:
...... ........
Farm Name:1... County.u+--'...................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: ..............................................................................'I'itie:................................... Phone No:
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative: .................................................................................................... ...... Integrator:.... 1................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude • Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I JCI Dairy
❑ Feeder to Finish ❑ Non -Layer JE1 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 I ❑ -ag-mn Area ❑ Spray Field Area
Holding Ponds / Solid Traps [[—:]No Liquid Waste Management System
Discharges & Stream Impact~
I. 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. ll'discharge is ohserved, did it 3-each Water Of the State'? (Il'yes, notily DWQ)
c. If discharge is observed. what is the estiinaled Ilow in gal/inin?
s
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 s(orage) less than adequate?
Structure 1 StrUCtUre 2 Structure 3
Identifies:......1. ... ..................
Freeboard (inches): 31
5100
❑ Yes qNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 4No
❑ Yes [�No
❑ Spillway ❑ Yes MNo
Structure 4 Structure 5 Structure 6
Continued on back

`t FacNty Number: T) -- Date of Inspection 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 ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
tTNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
jxrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'?
❑ Yes
allo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
14No
11. Is there evidence of over application?? ❑ Excessive Ponding ❑ PAN KHydraulic Overload
, Yes
ElNo
/ }
12. Crop type CI W ISs,�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
J�<No
b) Does the facility need a wettable acre determination`?
❑ Yes
IkNo
c) This facility is pended for a wettable acre determination?
❑ Yes
CjrNo
15. Does the receiving crop need improvement?
❑ Yes
J�<No
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Reauir•ed 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'?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
NrYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
' gNo
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
MNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit'?
Yes
f'No
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
W 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
VKNo
�'�Io yiQlaticjns;oi- deCde'nues were p6tec1- dirririg this;visit:- Y;oo :will -receive iio further; ,
correspondence:a'batit: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):
Kf
Y2 Gig v
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: a-Q --aG 5100

i�
Mlity Number: Date (if Inspection [T CN Printed on: 7r'21/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor hplow ❑ Yes P(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
9No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ftNo
ao-aj�uJ
ngs:
�e
5100
J

r ,
Division of Soil and Water Conserva`taon Operation`Review' `# 3 a :''E�'; ° ,!"} ✓
t
;[.Division of Soil and Water Cons6i*ation ;Compliance Inspection
Division of Water Quality . Compliance Inspection
© Other Agency -40 erai on Review 1
a E
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection C�PM
Time of Inspection Q 124 hr. (hh:mm)
Permitted [j Certified © Conditionally Certified 13 Registered r Not Operational Date Last Operated:
Farm Name: .... County: .... ..coe-4.................................................
OwnerName:........................................................:.................................................................. Phone No:.......................................................................................
Facility Contact: ............................ ........................................ ......:... Title:....................... Phone No: .....
......................................... ........................ .....
MailingAddress: .................................................................................................................................................................................................... ..........................
Onsitc Representative:....W�`2�f...........................................................I................ Itttegtator:.... "'........................................
Certified Operator: ................................................... .............................................................. Operator Certification Number:..........................................
Location of Farm:
i
,...................................................... ........................................................................................ ..... ............. 1
Latitude �` Longitude • �° ��°
Design Current.' Design Current Design Current
Swine Ca acit Po elation Poultry Ca acit Po elation Cattle Capacity Population
❑ Wean to Feeder i' ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer " ❑ Non -Dairy "„
❑ Farrow to Wean
El Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity
❑ Gilts
'I 1t Ij�I ,n,t1t!-�.
❑ Boars 1'' "i ' 'PotA LW
Number of Lagoons. ❑ Subsurface Drains Present ©Lagoan Area ❑ Spray Field Area
t�
iHokitng Ponds '/ SoI Trays ❑ No Liquid Waste Management System 3
�'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
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/ruin? _
d. Docs discharge bypass a lagoon system? (If yeti, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes cs�`No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard(inches): � ...............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3/23/99 Continued on back

t
Fad' ty Number: ) Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type Sc1''W a` , ��
13. Do the receiving crops differ Iwith those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel 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?
1 yigEatiQris'o dg#ic en�fes wore otoec1• 04tiog this'vish; • ;Y;ojx wvfl •ee1 C t}o; ful th�f•
;correspondence. ab"f this visit.. . • • • • • . • • . • • • •
AYes ❑ No
❑ Yes N No
N(Yes ❑ No
❑ Yes $No
❑ Yes [�fNo
❑ Yes 9 No
❑ Yes 9No
❑ Yes � No
❑ Yes 9 No
❑ Yes IM No
❑ Yes [�No
❑ Yes ONO
❑ Yes [�rNo
❑ Yes XNo
12ryes ❑ No
❑ Yes ZNo
❑ Yes [2�No
❑ Yes Cff No
❑ Yes 19 No
❑ Yes XNo
❑ Yes [XNo
Comments'(ri fer to question #) Explain any YES ans�vt rs atidlor any recommendations or lfj�.J othfertcomments ; n
Use drawings of facility to:better explaintu siations (use�additional pages asmecessary) �h�k 111i
LeVj
�R 1 �t � � Q��l l+��o ✓�..C�+�.S � ��Ki-L-k 'es pe C(Gl l � .� ✓Zy� . Ll "�� C� 1C��41N
CY
Reviewer/Inspector Name
Reviewer/Inspector Signature: Q , ���� Date: j 0
3I23199

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes [INo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes MONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Ycs 9No
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 NNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32, Do the flush tanks lack a submerged fill pipe or a perinanentltemporary cover? ❑ Yes 9No
AdditionalComments is a a/o Drawings:
n r rawen
cU
3/23/99

13 Division of Soil and Water Conservation ❑ Other Agency
J'Division of Water Quality
JJLRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection (v
Facility Number
Time of Inspection D o 24 hr. (hh:mm)
D Registered 11 Certified KApplied for Permit [3 Permitted 113Not Operational I Date Last Operated:
Farm Name: ...... 66.....PQ .... !h ............. County: ......
Q Y5L.1!y...................................................
OwnerName:..rkfte.41l .....�................................. Phone No: ........ 73. �..r...................................................
Facility Contact:....ir!it�f.........,1...?.... Title:....{.:��,e.............................. Phone No:.....................�.....
/_ S S
Mailing Address:.. hP.....1�..,e�!v6r.1111*...QP.......,�,Y561l r................ ..........................
Onsite Representative:.....�QN7v�ft7 ....... /1 ��J.............................................. Integrator:......lNi���iN
.......................................
Certified Operator ;....... k 4-.)Vj mot... /�� �s,5................................................ Operator Certification Number,......
.... ................
Location of Farm:
Latitude ' =11 =11 Longitude 0' =' ®"
T" Design Curonk Desigd Current ;b Design. Current a
Swine w x Capacity 'Population outt y Capacity Population ` Cattle Capacity Population ,§
FWean to Feeder ❑Layer ❑ Dairy
Feeder to Finish V, ID Non -Layer I JE3 Non -Dairy. Farrow to Wean....'
El Farrow to Feeder, ❑Other
Farrow to Finish A
} Total Design Capacity,
Giltsx
❑ BoarsTotal SSL'W N
M g`
y
�w
, W
`z r`
Number of. I moans / Holding Ponds �} ago Spray Fie ea
�4s 4 ,' k � f� ❑ ubsurface Drains Present ❑ Lagoon � Id Ar Area �
t
' No Liquid Waste Management System q g,
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
❑ Yes P(No
❑ Yes ANo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes JXNo
Yes ❑ No
❑ Yes XIo
❑ Yes o
❑ Yes �<No
❑ Yes )/(No

i :i }Z%
Facility llumhvr:Lj" j —
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Lazoons,Holdiny Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
[]Yes �No
❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
llII 1 j 1 ,d
..i.V.:..�"�:o-........\...........�..!.ofrX!-Q ... t R- ...
Freeboard (ft): .,...,... 01 I OK
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 mairuenance/improvement`?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste :Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
❑ Yes �(No
❑ Yes A No
ffir.Yes ❑ No
❑ Yes AN
❑ Yes XNo
15..Crop type ...1!'1 A.9,�..... wy. tTa.... .O.R.414.t..... , �.�s U......................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes X\10
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
No.violations or deficiencies were note'd-dur'ing this.visit..You will receive no further
correspondence ah:oiit this',visit"... , .
❑ Yes gNo
❑ Yes VNo
❑ Yes o
❑ Yeti \'o
❑ Yes ANo
lYes ❑ No
Cl Yes kNo
Cl Yes No
Cl Yes No
Cnmmen ts;(refer to question#): ,Explain any Y'ES answers and/or atn reeor6inendations or any other comments
Use drawings of frcility to better explain situatio ns ("usc "additional pales"as'neccssary)
Z �" Iroo"k co cry �- 141 � L g, , 40.....
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: jh he, /f F

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor BY.
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
July 2, 1998
Franklin Riggs
Riggs Pork Farm
284 Hampshire Lane
Maysville NC 28555
Dear Franklin Riggs:
ECEIV
E • •
JUL 0 6 98 — — f
N C D EN R
NORTm CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Application No. 67-0063
Additional Information Request
Riggs Pork Farm
Animal Waste Operation
Onslow County
The Non -Discharge Permitting Unit has completed a preliminary engineering review of the subject
application. Additional information is required before we can continue our review. Please address the following
by August 1, 1998:
1) The application form for the general permit is missing in your package. Please fill out the relevant
portion on attached application form for submittal to this office.
2) A land lease agreement for Tract N. 2357B Field 14 is missing as part of the waste utilization plan.
3) Various irrigation parameters by soil type (such as application rate and application amount) are
missing in the waste utilization plan. Please keep the application amount to a maximum of 1" per
application event or have justification for amounts exceeding I" per application event.
4) Please clarify the number of lagoons and storage volume (cu. ft.) in each of the lagoons present on
your farm.
5) Copy of the animal waste management certification form is missing in the package.
Please reference the subject permit application number when providing the requested information. All
information should be signed, sealed, and submitted in duplicate to my attention at the address below. The
information requested by this letter, must be submitted on or before August 1, 1998 or the Division will return
your application as incomplete in accordance with 15A N.C.A.C. 2H .0200 and your facility will be considered to
be operating without a permit.
Please be advised that operation of the subject animal waste management system without a valid permit is
a violation of North Carolina General Statute 143-215.1 and will subject you to the enforcement authority of the
Environmental Management Commission.
If you have any questions regarding this request, please call me at [phone], extension 363.
Sincerely,, j
C�
JR Joshi
Soil Scientist
Non -Discharge Permitting Unit
cc: Wilmington Regional Office, Water Quality
Permit File
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

6 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection � Z
Facility dumber 3
Time of Inspection l� IS Use 2� hr. time
pp Total Tune (in hours) Spent onRe%iew
Farm Status:..... �cf.,r?z » _ .... _....
"'� �'� or Inspection (includes travel and processing)
Farm Name: _ (�G5 C_ _
...4 ,2vv► _....
_..._ County:......
(. y s ? ,v.... .................. __ ._ .... _. ..
Owner Name:....Ari.SGI i i1> _..._ ........�irS
._
�........_ Phone
1lfailingAddresst._�1�_.�Ln�. L�._.. 2� _lG� �41g�1G,c[Fd .... ... Z�s,
Onsite Representative: Integrator:
Certified Operator: _ --- __ LC_.2.. a ..,... Operator Certification Number:
Location of Farm:
Latitude 0'O4. Longitude • 1 49
0 Not Operational Date Last Operated: _ ._ _. _... r..___ .- _....-.....^..._ __....r......—....�---
Iy-pe of Operation and Design Capacity
, w: ray
--- z•mm
t ..13-: �� _ �.. ;w �s ,,.i _ : _. .s -., •., --;,,,
Number M r Pou`l"Number Cattle;,Nuatbei= x
x}'...�..._.. y
❑ Wean to Feeder
❑Laver ❑ Dairy
❑ Feeder to Finish
J ❑ Non Laver ❑ Beef
Farrow to Wean
Farrow to Feeder
x
'
Fa w o t Finish
Farrow
�
s ❑ Other Type of Livestock >
� 1
k-Yx
' Number of Lagoaas f HaldingPa�nds "3 ❑ Subsurface Drains Present
;�f u 3 a•,°0�`� r x-� �a�.��." t r �,e�, '��. ��"^� �'� ..r;u'.a:c � x e�xYd;i��'A''� �' � w� � a
0 Lagoon Area ❑ Spray Field Areas` 'M
'xt I. +•Ar n,,.. ��1:J'?'�eiv egiy,wow.h Y`.•A:. a.C. :es'�,., ^s;A,:.. -r
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge obsen-ed from any part of the operation?
a If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
i. Is there evidence of past discharge from any part of the operation?
v 4. Was there any adverse impacts to the waters of the State other than from a discharge?
❑ -Yes
ckl1 o
❑ Yes
Gi<
❑ Yes
2-15—o
❑ Yes
M-NO
❑ Yes Efio
❑ Yes 9 No a0
El Yes C?�4o
Ly'Yes ❑ No
S. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?

6. Is facility not w' compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after l/1/97)?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or IioldinLPondsl
9. Is structural freeboard less than adequate?
Frceboard (ft): Lagoon 1 La_oon 2 Lamon 3
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)
13: Do any of the strictures lack adquate' markets to identify start and stop pumping levels?
«`ante Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
16. Do the 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 Oniy
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facilityfail 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 Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes Eavo
❑ Yes Goo' "
D'Ves ❑ No
24c's ❑ No
Lagoon 4
Z
❑ Yes ER50
[des ❑ No
res ❑ No
[1es ❑ No
❑ Yes M No
❑ Yes GI -KO
❑ Yes Q. O
❑ Yes 0-5o
❑ Yes 2<10
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes "�'o
❑ Yes
❑ Yes 21] o
ate..-�
„Comment {refer to quest�on.ir} Lcx Iam any YF.S answers and/or anyiecommendauons or any other comments
-:
Li'se drawtngs_ of facility to better expl�arn situattons.use ,additianal.pa$e �a�s necessa�),��;� � .,� :.;,,� �;
�� i� v l f5 � ar n,�cc� To /9 Vo i r� �QoSlc�!'r . LAMA JW 6-
PS P_,�? N5 /.c�v,2.�s% LrI rnA�z .f
r
a
Reviewer/Inspector Name T'rW =
--F
Reviwer/Inspector Signature:
Date:
cc. Division of Water Quality, Water Quality .Section, Facility Assessment Unit 1 1/14/96