670079_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual
II

3
(Type of Visit: Q'C once Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ _Q r—la tvol' r/I V
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design
SW ne Capacity Pop. Wet Poultry Capacity
Wean to Finish La er
Current
Pap.
Design Current
Cattle Capacity Pop.
Dairy Cow
W an to Feeder Non -La er
Dairy Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
IDesign
I) , P■ouItr, Ca aci
Layers
Current
Dry Cow
P,o
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I
10ther
Turke s
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes G-Vo J ❑ 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 tNo ❑ 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 .n No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, 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 rNo❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No -NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
ro[OD
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
YNo
❑ NA
❑ NE
Required Records & Documents
�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
❑ NA
fNo
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: i
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes PAM"
❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F]-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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes _E]-NU--❑ NA ❑ NE
❑ Yes ❑ No [3-N7V'- ❑ NE
❑ Yes l2-1VO D NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑-go'[] NA
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q o ❑ NA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑-Afo ❑ NA
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E3-?1U--. ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Name: w� ``� M" Phone: Io
Reviewer/Inspector Signature: Date: k
Page 3 of 3 U 2/4/2015

Type of Visit: Q Com fiance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 0® Departure Time: _ I f L County: CWSLeiJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 'oA hkn-L6YL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I tW
Certification Number:
Longitude:
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [—]No ❑ NA [] NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 9,yNo
o ❑ NA ❑ NE
0 Yes ❑ NA ❑ NE
Page I of 3 21412015 Continuer)

Facility Number: - Date of Inspection: 4
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
Struck ture I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: hl��NJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2E
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
ZNo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 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 1/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 ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes oeNo ❑ 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
[Yes
❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Wo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
c `''o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;k/ o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes�Y<o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [—]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below.
❑ Yes
Q 0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectiVNc
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
&No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes ][� ❑ NA ❑ NE
2S. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [rNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3'<o ❑ 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 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 [2No
❑ Yes [2/No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes CTNo ❑ NA ❑ NE
No ❑ NA ❑ NE
❑NA ❑NE
[�No ❑ NA ❑ NE
❑ Yes
❑ Yes
Comments (refer to question 4): 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).
151) 41t(-TJ Uyc\Cl
Reviewer/Inspector Name: '_� W +j &'� L L',L'
Reviewer/Inspector Signature:
Page 3 of 3
Phone -->S�
Date:
21412015

(Type of Visit: (Z) CopSpliance Inspection U Operation Review 0 Structure Evaluation 0 'Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access 11
Date of Visit: j Arrival Time: Departure Time:® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
r
Onsite Representative:
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator: /
Certification Number: (� t
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C►urrent
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish g
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
Dt, P.oult . Ca acf P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lPtppf
Brood Cow
Turke s
Other Turke Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [ZI/No ❑ NA ❑ NE
[—]Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes dNo
[:]Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

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

Facili Number: - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes�/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
ZTNo ❑ 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
LJ o ❑ 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 <o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C No ❑ NA ❑ NE
No ❑ NA ❑ NE
Rio ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. e
Use -drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon(� .1
Date: '211 [p 1
21412015

Type of Visit: Q C pliance Inspection U Operation Review O Structure Evaluation p Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time:® Departure Time: County: OWL6-�j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Jo 13Integrator:
Certified Operator: Certification Number: {pa
Back-up Operator:
Location of Farm:
Wean to Finish
La
Wean to Feeder
or
Non-L
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P'
Layers
Gilts
Non-L
Boars
Pullets
Other I I I®I 10ther
Latitude:
Poults
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
[] NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes FN
❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fac I ility Number: jDate of Ins ection: i' 1
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 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 0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ YesVNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[-]Yes P/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes U/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
t5. Does the receiving crop and/or land application site need improvement?
❑ Yes FN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records &_Docu_ments
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall InspectioFNo
22. Did the facility fail to install and maintain a rain gauge?
[] Yes❑
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes❑
NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 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 2<9 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes 2fNo ❑ NA ❑ NE
❑Yes S'-'No ❑NA ❑NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No [INA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑Yes L.d'"" ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 /No, ❑ NA 0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes rNo ❑ NA ❑ NE
Comments, (refer to question #): Explain: #ny;YES answers and/or any additional recommendations or any, other comments.
Use drawiriesoffacility to better explain=situations (use additionalpii�es;as�necessary). `.
Reviewer/Inspector Name:
kl)
Reviewer/Inspector Signature:
Page 3 of 3
Date:
12144141

Certified Operator:
Back-up Operator:
Location of Farm:
Type of Visit: m XRoutine
mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reasonfor Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:-J County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: L j J iQ'Yj A� !V f�.C.(.J`�n , Integrator:
Certification Number: 16 �2'6 1
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Design Current
Design Current
apacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop
Finish
rFeederEto
La er
Dai Cow
Feeder
Non -La er
Dai Calf
Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
\
I]r, P,oultr. Ca aci l',a ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N NA ❑ NE
❑ Yes VN
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

F'acili Number: jDate of Inspection:
Waste Collection & Treatment
4! Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2rNo ❑ 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
1
Identifier: �'1[TaC�"j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes 2J'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I ,�No ❑ NA ❑ NE
maintenance or improvement? 777"'
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
LjNo
Mn❑
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
I �J 7 es
❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�rN
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �/N
❑ NA ❑ NE
23. If selected, did,the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? I ❑ Yes � ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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
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 ENo ❑ NA ❑ NE
[] Yes 0<0 ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes 2jeNo ❑ NA
❑ Yes 6 ❑ NA
❑ Yes No ❑ 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).
/'S Ij- K;C- &606
Reviewer/inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
❑ NE
❑ NE
❑ NE
Phone: JJU -'
Date: 0
h A
2 4/2r9 I

�l
Type of Visit: (rCo fiance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:)VAOKJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Wean to Finish
La er
Wean to Feeder
Non -La
Feeder to Finish
Dr, Poi
Layers
Farrow to Wean.
Farrow to Feeder
Farrow to Finish
Gilts
Non -La
Boars
Pullets
Poults
Other I 1 101 10ther
Phone:
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?
Phone:
Integrator:
Certification Number: _�rpa6
Certification Number:
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?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ZN9,
❑ NA ❑ NE
❑ Yes [] NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: -
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
Structur--eyyI Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 0I�rN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RjrNo�' ❑ 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 hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 4 ❑ 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 O/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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
6 ❑ 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
VN ❑ 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
0 ❑ 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
2 o ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ 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 geo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

F'acili Number: - Date of Inspection: S Zi
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesVN'o
❑ NA ❑ NE
25. Is ll�c facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑Yes ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes L`J No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
o
�o
No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional Dap -es as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: [phone]
D�
Date:
21412011

Type of Visit: Qf Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency C) Other 0 Denied Access
Date of Visit: Arrival Time: j y D Departure Time: [E= County: 446U 1%/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: _jd)VkP& LLLIM Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design
Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity
Pop.
Wean to Finish
I
ILayer
I
airy Cow
Wean to Feeder
Non -La er
I
ai Calf
Feeder to Finish
Dairy Heifer
' Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
01
113eef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:717-ijil
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: [A 600ZW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
FNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
WNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes jo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CjNo ❑ 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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:)Yes No ❑ NA ❑ NE
t t�
mom enance or improvemen .
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 t0 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 Ej
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yesgo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ZI o
❑ 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.
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2 N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Ds ection:
24. laid the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA
�fNo
❑ NE
25'1Is the facility out of compliance with permit conditions related to sludge? If yes, check
0 Yes
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[] Yes
BNo ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
ff/No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
�No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E3No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
EJ/No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were CAWMP?
ZN5
any additional problems noted which cause non-compliance of the permit or
❑ Yes
NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ 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 comri�entsi>'.i,•L"
Use drawings of facility to better explain situations (use additional pages as necessary).: : ' , ,, a 4; r ff�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2141201
-73

b,`y.:''
Facility Number
.r`Conservatip
rit''
Type of Visit Q(Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
,/
Reason for Visit � Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (, Arrival Time: ® Departure Time: County: VQQ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ff rTitle: Phone No:
Onsite Representative: L16�� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e = ' 0 Longitude: = °
I ; , a�? $,
a Design Current` s Design Current h;. �,, Deslgn4,Current
'i kq. '; ° Ne: ;L xg € , a'�pa: r t ` 7 : - 5i .4£*i x.� ±
Swmc`s Capacity 1?opulahon `Wet, Poultry Capacity Population r Cattle ,re$ Capacity Population �I
❑ Layer ❑Dai Cow.
�❑ Non -Layer ❑ DairyCalf§
� El Dairy Heiferit
�
Poultry ❑ D Cow
❑ Non -Dairy
`r ❑ Layers
❑ Beef Stocker
❑ Non -Layers
. ❑ Beef Feeder
A ❑ Pullets El Beef Brood Cow
❑ Turkeys
Otber �; p 9 t t
� s4'k § �.a ❑ nrke PoultS � � ..t
10 Other El Other Number�o# Structures
[]
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
L p
Farrow to Wean
�
Farrow to Feeder
❑Farrow
to Finish
❑
Gilts
` ❑Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑N' ❑NA
❑NE
❑Yes
❑ Yes
lLl N [INA
❑ NE
ElYes
No ❑ NA
❑ NE
12/28/04 Continued

Facility Number: Date of Inspection
` Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes L{ 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: LIQ T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dN
❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El 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 environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U `V 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 [io ❑ NA ❑ NE
maintenance or improvement? J
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes d No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Z! No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
El NA
El NE
,I�TNo
1a No
❑ NA
❑ NE
�/No
❑ NA
❑ NE
0 No
❑ NA
❑ NE
r No
❑ NA
❑ NE
Comments (refer' to question #): ' Explain any YES °ans*ers and/or any reeoirimendattans or any otl er.co��eients
.Use drawings. of facility to better ezpI' in situations: (use iddition'al pages as necessary) �
ReviewerlInspector Name '' §�(� s��:` Phone
ReviewerlInspector Signature , �, , Date: o b
noa 7 of 7
12128104 "Continued

Facility Number: — Date of Inspection
J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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
❑ Yes EZo
❑ NA [I NE
El Yes ❑ NA ❑ NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
I N
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNsEl
NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fo ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes��No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo ❑ 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
M No ❑ NA
El NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El:No
N ❑ NA
El
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

is I H I I
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7, Arrival Time: Departure Time: County: _OAISL-12h) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
yy�l
Onsite Representative: „ „c,�o1✓J91'�i1✓___ ►I �l (.fin
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: a 0 { = Longitude: C
o = 1 ❑ fl
Desigu Current Design Current
Design C►urrent
Swine Capacity Papul�at on Wet Poultry Capacity Population
Cattle C*apacity Population
❑ Wean to Finish
La er
❑Dai Cow
n to Feeder
Ej Non -Layer
❑Dairy Calf
Feeder to Finish
rqt4av
❑ Dairy Heifer
❑ Farrow to Wean
Dray Poultry
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
I
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
❑ 'I'urke s
Other
❑ Turke Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
❑ NE
❑ Yes
El Yes
VN El NA
❑ NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: 61 — Date of Inspection ?
1
Waste Collection & Treatment
4. I� storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure
l+ I Structure 2 Structure 3 Structure 4
Identifier: CArrd6lV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ii
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 7No
ElNA ElNE
❑Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA [!IN E
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes I''rNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1 I 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 LI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs El 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 El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
[go ❑ NA
[go
El 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
Zo ❑ NA
2N,'o
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
NA
C3 NE
rx"q:a _.`.R`:�:-;a yti'�'eii-a.k .'v
Comments (refert� questeon#) _, Explain anykYE$;'answers aril/or any: recommenc�ations,nr�anyothercommentts.; '
W11t o-�
1,USpg drawings al 1;1011t to better, ex lain situations. use'add4itional a es` asinecessar
44 g: :'.}> Z:c §'�. ;: $�. SR .{S —.�4 "$� .��a.4�� •}r�i� L�VIf.. 3'bA: l -�!4 �f.n ��
i
T
Reviewer/InspectorName I 6 T �-i.
Phone 7 ri3
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: —21 Date of Inspection
Required Records & Documents
19.i Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CNo ❑ NA ❑ NE
the appropirate box. ❑ WDp 0 Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2K o ElNA ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit`? ❑ ,
Yes N ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes L.d o ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes ,� N El [I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes LAN El NA El 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 N El NA El 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 N\a ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? El Yes No ❑ NA ❑ NE
AdditionafCornments and/or Drawings: ,:...
Page 3 of 3 12128104

I H 'I 4k
Type of Visit O(�Xoutlne
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: `] 6 Arrival Time: i 2�0 Departure Time: County: 6 ju Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 h Title:
Onsite Representative:i�1�U
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = I =61 Longitude: ❑ ° = ' ❑ «
Design Current
Design C*urrent
Design Current
Swine
Capacity Popurl�ton
Wet Poultry CapacIS ity Population
Cathie Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turke Pouets
❑ Other
❑ Other
Number of Structures: a
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
❑
[I NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
Y
[I NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El
Y
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Fpcility Plumber: — Date of Inspection Id b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental th eat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
!(J 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
E2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
/o
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA ❑ NE
maintenance/improvement?
7No
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 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
L[ o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
10 ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
11J No ❑ NA
❑ NE
;4 � l A16gb ZNOF AEC
Reviewer/Inspector Name p L Phone:r
Reviewer/Inspector Signature: Date: ` p
Page 2 of 3 1 12128104 Continued

Facility Number: ` — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes � N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Ch klit ❑ D , ❑ M ❑ Oth
ec s s es�r aps er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
/NNo
❑ 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?
El Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[jNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZN o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ es
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
,Ycs
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑' o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ iVo ❑ 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
P o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0No ❑ 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
2No ❑ NA
❑ NE
Additional Co"minen'ts�.andLor Drawin s: �. �,b a : ,t.� � .r ' � . �. ,Q_, � � �
Page 3 of 3 12128104

WDivision of Water Quality
=Facilityumber O Division of Soil and. Water Conservation /
0 Other Agency V
Type of Visit C�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit iCJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email: tiiNsi
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �Nry %%�— Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ e = ` =" Longitude: = o 0 ` ❑ `�
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer.
Dry Poultry
Pullets
U Turkey Points
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design.. Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N El NA
❑ NE
❑ Yes
❑ Yes
o El NA
El NE
El Yes
V❑ NA
❑ NE
12128104 Continued

Facility Number: 6j —7 qI Date of Inspection D
Waste Collection & Treatment
4.Collection & Tr ment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ll 3
Structure 4
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 V(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ YesNo ❑ NA ❑ NE
❑ Yes C No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement`? El Yes L-f No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes � No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
[allo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
I- o [INA
✓✓✓VT
❑ 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
2No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P,,No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary)-
Reviewer/inspector Name Phone: 7 .73
Reviewer/Inspector Signature: Date: v
r 12128104 ' Continued

Facility Number: — Date of Inspection ti 6
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 ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1"Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes [ No ❑ NA ❑ NE
❑ Yes ON, ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E'No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,�/
L'd 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
o ❑ NA
❑ NE
Comments and/or Drawings:
12128104

'acili Number V vision of Soil and Water Conservation
Division of Water Quality
Pll ly
— Q Other'Agency:
Type of Visit 0 ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit WRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: Depa ure/Time: C� County: Region:
Farm Name: /✓f � /���F f �Cr� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: G Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = i Longitude: = ° 0 i 0 «
Design Current Design Current
Swine Capacity "Eopnlation Wet Poultry Capacity Population Cattle
❑ Wean to Finish
10 Wean to Feeder
❑ Feeder to Finish I6&10 1
LJ Farrow to Feeder
❑ Farrow to Finish C
Gilts
Boars
Other
❑ Other _ _t
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
j
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood'Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — 7 Date of Inspection G
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 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.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Ace ptable Crop Window 0 Evidence oof' Wind Drift ❑ Application Outside of Area
/ � � �]
12. Crop type(s) /'� ) �C7L�//�/�P�c� ) 7� 5"C-GG(_ _9 -/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question 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):
Reviewer/Inspector Name !' ` Phone:
Reviewer/Inspector Signature: Date: rG 3 J-Bt�
Page 2 of 3 12128104 Continued

1Facil4y.,Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design [I maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. id the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
0f116 o �y
r
Page 3 of 3 12128104

Type of Visit (3 CCorliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (Y outine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
J Arrival Time:
,(PPAQp �
Departure Time: County: Region:
6�Slow/
Owner Email:..._...
Phone:
//��
Phone No:
Onsite Representative: CeW Integrator:
Certified Operator: Jr����� �y Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Title:
Back-up Certification Number:
Latitude: 0 0 ❑ A = Longitude: = ° ❑ ' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
J ❑ Non -La et
Dry Poultry
❑
La ers
❑
Non -Layers
❑
Pullets
❑
Turke s
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairylleifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 61— `� Date of Inspection 5-
V
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: CA!6 � _ __
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
Cl Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes UNo
❑ Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th t, 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:rNc ❑ 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 LI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (xn,rvu ok CO S C-y F'6SC'UIL (A)
13. Soil type(s) G 1, A R, A N D 0 _,(
14. Do the receiving crops differ from those designated in the CAWMP? El Yes ICJ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0Yes ❑ o ❑ NA ❑ NE
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?
18. Is there a lack of properly operating waste application equipment?
1S.) fjetbS fJe-A.D S,nnE 1JEEC� CONAWAt< .
Iv6_ D J<r_ e P' "C 4-0 aF SW O d— GA1�3636 T pJ
❑ Yes
❑ Yes
[I NA ❑NE
❑ NA ❑ NE
❑NA El NE
t4:1�rl-k 6?.0 ca DS._ 4(Jo
5 �-r t; �,
Reviewer//nspector Name 6 n' Phone$ ��fr —,j110 pt UP
�,,- �� .
Reviewer/Inspector Signature:%Z.,_Date: 01 6 S!
12128104 Continued

Facility Number:_ ,L %q Date of Inspection
i`
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZTro ❑ NA ❑ N1
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
ElYes
d4o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the pen -nit?
El Yes
ZN
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
l�J NN
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA�NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ 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
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
ErNo
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
I
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
ffNo
❑ NA
❑ NE
Addition al Comm ents2and/or Drawings;
12128104

Q,
Facility Number
Date of Visit: L 'Time: /Z; Q
-7
Not O erational OBelow Threshold
Z Permitted ISCertified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold•.
Farm Name: 4,
a �/Y; �t.�� County: el "z,.,,
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:�s--xR ® A,ti�1�y
Phone No:
Phone No:
Integrator: yr
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude
Design
Current Design
Current Design Current
Swine Cavacitv
Population Poultry Capacity
Population Cattle Capac-itv Population
❑ Wean to Feeder
❑ Layer I
❑ Dairy
® Feeder to Finish
❑ Non -Layer I
ILI Non-Dai!ji.
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design. Capacity
❑ Gilts
❑ Boars
Total SSLW
Number. of: Lagoons
❑ Spray Field Area
, ❑Subsurface Drains Present ❑ —Lagoon Area ,
Holding Ponds /,�Solld Traps
�7 4 ❑ No Liquid Waste Management System e
_..
.„ ,.
ter•..
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
W, aste Collection _& Treatmertt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: C] — 71 Date of Inspection � V i
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
8. Does any pan 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 Aoniication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application?
�� ❑ Excessive Ponding ❑`` PAN
S [I Hydraulic Overload ❑ Yes ❑ No
12. Crop type Ae6 - i . 'T / - �� er.'e! �
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
I4. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes (I 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
Rewired„Records & Documents
17.
Nail 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.
',<< _�. ,�_ -, �� � A :au.s.r^�r--�:� .� ns;•�-,.�- �r r�;E, a s
CaIIiments"{refer to question . Ezplaus aAy YES sosweirs;sad/orany,recommendshotts arty o6er comments,
�r
Use drawing`s of facillity to better explain sittiattons..(nse additiobal pages as necessity) }+t .t Field o Final Notes
Copy ❑
"`
m.1-+l . ,s..r-••�•�rrwe-xus�..v.-�•-5
��
•
;
Reviewer/Inspector Name-let����zw ,.
.,-�
e ti >.a s� iO3°F"E.
Reviewer/Inspector Signature: Date: M2e b�c
05103101 "r U
Condnued

. I :a
Facility Number: 7 — Date of inspection
Odor 1Ssuec
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?
2T 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 caver?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
05103101

Facility Number Date of visit: 7 Z Time: 9.'3d�
Not O erational 0 Below Threshold
19 Permitted 13 Certified D Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: de-o-V jgeA94/mil County:
ins/a a✓
Owner Name: Phone No:
Mailing Address:
Facility Contact: /� DD Title: Phone No:
Onsite Representative: ��� 4 / Tess 4R s'CLi Integrator: e sx�/[ zC
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 04 66 Longitude • 1 �K
Design Current Design Current Design Current
Swine Ca aci Population Poultry Capacitv Po ulation Cattle Capaeltv Population
❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish ❑Non -La er ❑Non -Dairy
❑ Farrow to Wean
-- - r
;, ❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity i
❑ Gilts
❑ Boars Total SSLW'
1V umber of Lagoons` ❑Subsurface Drains Present ❑ La oon Area ❑ spray IField Area
..b Pnniic 'ltCnlirl 'I'rnnc �� i� N., t i.... i.l Waif.. Mnne.,a..,nnh C,�ho.., f^;1'� _' �'-'.•�G::..
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JgNo
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 JR No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
WadCollection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes CgNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): ZY
05103101 Continued

zrl
Facility Number: — Date of Inspection 7 Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AnDlication
❑ Yes %No
❑ Yes RNo
❑ Yes B:N0
❑ Yes ELNo
❑ Yes XNo
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
Wo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic
❑ Yes
E�No
12.
%Overload �j
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9No
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
ELNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
�SjNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
QNo
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
CffNo
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
R No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
5.No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) Yes ®Nv
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes J4 No
24. Does facility require a follow-up visit by same agency? ❑ Yes CRNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes R No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cominen�s (Merto question #):' Explain"iioyNYES�answers,andlor eny.recammendations�or anytatlicr�comments,`'" �
Use:drawingoffacilit to' better ex laicsituations (fuse additional;'pa es as necessary)
❑ Field Copy ❑ Final Notes
� -��'rVss
fey��� Ate, �/� w/ffter -AKA. -��.
A-11
g do-/ 7Z" V ecd12
,y.
Reviewer/Inspector Name
ReviewerlInspector Signature:
Date: 23 ! Z
05103101 1- Continued

Facility Number: G7 — Date of Inspection
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e• broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 25-No
❑ Yes �No
❑ Yes C.No
❑ Yes V'No
❑ Yes ,�SNo
❑ Yes JR[No
❑ Yes QNo
Additional: Comments aiid/or Drawings:-;..,_F , .
05103101
05103101

,,,,.y
DFHS16n Of Water Qn811tj' n i twl�h i f� F p d�i k
` DMslon O: 50i1 and Water CORSL'rVZtApn
n1,
Type of Visit PCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 9.Poutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date or Visit: Time: � Printed on: 7/21/2000
Qrational Q Below Threshold
Opermitted © Certified ❑ Conditionallly Certified 13Registered Date Last Operated or Above Threshold: .............
Farm Name: �...... � County:....................................I...... ........ I..............
yr ............... ...........I.......................... cr v
OwnerName: ................................................... ........................................................................ Phone No:.................................,.....................................................
Facility Contact: ...Title: .,,, Phone No: ,,,,,,,,,,;,,,,,
MailingAddress: ............. ............................................................................................................................................................................................. ..........................
Onsite Representative:+' Integrator: ,,,,,,, y�1.r
........................................................................I............ . 5..................................................
Certified Operator: ........................................... ........................... ................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �� Longitude
Design Current. Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Feeder to Finish m ❑ Non -Layer I I ❑ 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 110 Lav-n Area ID Spray Field Area
Holding Ponds/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream I.muac.LS
I. 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) [I Yes ❑ No
c. II' discharge is obsorved, what is the estimated flow in galhilin?
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 J<No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,D�'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes jXNo
Structure I Structurc 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........ ............................ ................... ................. ................................... ....:........... .................... ............................... ................ .........
..............
Freeboard (inches): 3S
5100 Continued on back

Facilit Number: — Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes kNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes RrNo
(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 J�rNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes V'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes WNo
11. Is there evide Efoverpplication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes h�'No
12. Crop type ✓�2 V-r-. Q ll t� , a Q4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
I4. a) Does the facility lack adequate acreage for land application? ❑ Yes (�No
b) Does the facility need a wettable acre determination? ❑ Yes G�No
c) This facility is pended for a wettable acre determination? ❑ Yes [No
15. Does the receiving crop need improvement? ❑ Yes XfNo
16, Is there a lack of adequate waste application equipment? ❑ Yes RNo
Required Records & (Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes Iro
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Cl Yes
kNo
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
WNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N o
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
�
Lry 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
4 No
24. Does facility require a follow-up visit by, same agency?
❑ Yes
ArNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
i9No
�V'0. i. aiipnjs;oi' ftficjencies -W're noted• O(Wift �his;visit; Yo0. . I i eciye no; futtho
corres' oric#eitce: abvuk this visit. ' ' ... ' . . '
Comments (refei to question #): Explatn;any YES, answers and/or any recommendations or any other comments i
Use drawings of facility to better explain situations. use additio>al pages as necessary)*.
! `
1 YG� � 1�G���i' �� � � GV �CL+`�.T- • 1'-'c'� L�p �-Q � � L�/o
� t
A.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
i�
■w r�rr��
Date: 5100

�. Faciiljity Number: — Date of Inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Cj&o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0 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 ONo
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 KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes MNo
J
5/00

X
VDivision of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit xRoutine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: ®rirne: L_.11�.—.J Printed on: 7/21/2000
EFacility Number
Q Not Op
erational Q Below Threshold
Permitted © Certified 0 Conditionally Certified 13Registered .Date Last Operated or lbove Threshold:
n
Farm Name: � .. County: 10.. r-!......................................................
.........................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:........................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative: ... GcQ!.......................................... ......... .. Integrator, ....1'C�...L......................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location or Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° .6 Longitude • 6 44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 6LIQ6 C/e,) ❑ Non -Layer El ❑ 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 ❑ Lagnan Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharl,yes & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. li' discharge is observed, was the conveyance titan -made? ❑Yes ❑ No
h. If discharge is observed. slid it reach Water ofthe State'? (If yes, notify DWQ) [] yes' ❑ No
c. II discharge is observed. what is the estimated flow in gal/min?
d. rocs discharge bypass a lagoon system?(If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation'? — ❑ Yes b�No
-3: Were there any adverse impacts or potential adverse impacts to the Waters of -the State other than from a discharge? •❑ Yes 9No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) lest than adequate'? ❑ Spillway ❑ Yes Y!�rNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure.6
Identifier:............................................................................................................................
............ .................................... ....................................
Freeboard (inches):
5100 Continued on back

lracil#ty Number: — M Date of Inspection Printed rrtt: 7/21/2000
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? ❑ Yes ENO
(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
jtg'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
b�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONo
Waste Application
10. Are there any buffers that need maintenancelimprovement?
El Yes
2QNo
11. Is there evidence of ov r application? ❑ Excessive Pond ing []PAN ❑ Hydraulic Overload
❑ Yes
ONO
12. Crop type
13. Do the receiving crops di fer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
t6No
14. a) Does the facility lack adequate acreage for land application'?
❑ Yes
`KNo
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?
s
❑ Yes
XNo
16. Is there a lack of adequate waste application equipment!
❑ Yes
XNo
Rupdred 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?
Yes
VNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement'? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
WNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes WNo
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
-N*0 •yiol'ati0iis vT d,Okie'ncies mere nbfe,d, during this:visit; :Moir 'w.ili r. eogiye f #further
correspondence. abaut. 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):
(
Gv� I
w
Reviewer/Inspector Name
Reviewer/Inspector Signature:
c- TV 3 7o o x-a�
— Date: G% C- oo 5/00

1~ikility Number: jg�7 — Date of Inspection (}O Printed on: 7/21/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor hlelow ❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
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 ONo
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 b'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �Q No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Z(No
A.Mitional Comments and/orDrawings:
ALI
J
5100

Revised April 20, 1999
,JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Numtv
-
Farm Name:
On -Site Represents ive:
Inspector/Reviewer's Name: Rom@
Date of site visit:
Date of most recent WUP: S,-d —C(
Annual farm PAN deficit: jqj pounds
Operation is flagged for a wettable
acre determination due to failure of
art 11 eligibility items} F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 ,E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: 1. hard -hose traveler, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system w/portable pipe;
B. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART €. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
JE3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75%rule exemption as verified in Part 111. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part 111).
'PART 11. 75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required -because-operation fails one of the eligibility
requirements listedbelow:
_F1 Lack of acreage :whichTesuitedin:overmpplicationmfw. astewater_(PAN) on -.spray.
field(s) accord ingfofarm's Jast-two-years mf mgation7ecords.--.
F2 UnclearjIlegible ,-or lack of information/map.
F3 Obvious field-limiiations-(numerous:ditches;failurefo:deductrequired:....
bufferlsetbackmcreage;-or25% of Total:acreageddentifedin-CAWMP. includes _ ..
small '-irregulady-shaped.felds � fields-lessfhan-5acresfor.travelers-or.-less1han
2 acres for. -stationary -sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part Ill.

Revised Apri120,1999
Facility Number •
Part III, Field by 1-iela uetermination
aT
ro% txemption
Kuie Tor VYH ueterminauon
TRACT FIELD
NUMBER NUMBER'S
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
COMMENTS3
1 I
I
::'. .•r
I
I
~ F
1
1
1
I
f
I
FIELD NUMBER' - hydrant, pull, zone, or.point numbers may be used in place of field numbers depending on CAWMP
and type of irritation system. If pulls, etc. cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise a operation will be subject to WA determination.
FIELD NUMBER' -must be clearly delineated on map. _ 4
COMMENTS' - back-up fields with CAWMP aCFeage-exceeding '75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous -two years' (1997 & 1998) of irrigation Tecords,-cannot serve as -the
sole basis for requiring a WA Determination.hack-upfields must-benoted in the -comment -section and must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
P1
Plan Jacks following -information:.
P2 Plan revision -may:satisfy75% rule based on adequate overall PAN deficit -and by
adjusting -all field acreageto below 75% use rate
P3 Other (ielin process of installing new irrigation system):

J
:f
Lagoon Dike Inspection Report
Name of Farm / Facility
Location of Farm / Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Sq. Ft.
Upstream Slope, xH:IV
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Barry 5heand Main Shtpard_ Farms)_ 67 - 79
R 1108
_BBry :Shepad, 109 Wi drill Lane . Jacksonville_
—,NC 28540 910-347-2357
9 27199 Names of Inspectors ZaWdKhan
Vincent Lewis
_ 10- 2 Freeboard, Feet 1.5 - 2.0.
50 Top Width, Feet 8 - 10
to -L Downstream Slope, xH:1v 4 to I
Yes _ X_ No
Yes _ X No
Yes _ X - No
Yes X No If Yes, Depth of
Overtopping, Feet
Yes _ X No
Yes . X _ No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes -- X No
Other Comments _Met with Ba1ry and Rabin 5henard Qwncr and inspected
_goon together.

ikf, Lf 0 Division of Soil and,Water,Conse
sr
�1 Division of Soil and Water�Conse
t ' r Division of Water Quality -,Carol
C1 Oth r Agency;- Operation ReAev
Routine O Complaint O Follow-uu of DWO insaection
vation Operation Review. k ' `
nation Compliance mspectlon
lance Inspection
of DSWC review 0 Other
Facility Number �� Date of Inspection 0 [ 7
-- - Time of Inspection E=24 hr. (hh:mm)
*Permitted © Certified [Q Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
ro
Farm Name: ..... Y `�. County:......4 a........................... .......................
OwnerName: ............................. .............................................................................................. Phone No........................................................................................
Facility Contact: Title'
Facility one No:
MailingAddress:................................................................................................................................................. ..........................
Onsite Representative: ���2 v Into rytor �� t
p.................. ......................................................................... 'g .............�'y�...........................,..........................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm;
Latitude 0 4 •1 Longitude 0 4 fi�
Design Current Design, Current Design . Current
Swine k?r`, Poultry ,Catl'CapacityPopulation P. Capacity Po'ulation ;
❑ Wean to Feeder
Feeder to Finish
�Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
° Ttital Design Capacity
r, 41
TotaUSSLW
Number of.Lagoons JEI Subsurface Drains Present ❑ Lagoon Area 10 Spray F�elai Area
HoldingTonds /., Solid Traps • , ,, ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ANo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
h. If discharge is ohserved, did it reach Water of the State? (Il'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 WN0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑C
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EgNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .....................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 5rNo
seepage, etc.)
3/23/99 Continued on back

99
Facility Number: Date of Inspection
0
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[:]Yes
XNo
(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
NrVo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
gNo
9. Do any-stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
(6No
Write Agplication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
MNo
11. Is there evidence of over plication? ❑ Excessive Ponding ❑ PAN
❑ Yes
RN
12. Crop type �j s-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
O'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
9No
b) Does the facility need a wettable acre determination?
❑ Yes
C'No
c) This facility is pended for a wettable acre determination?
❑ Yes
RNo
15. Does the receiving crop need improvement?
❑ Yes
DrNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
NfNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
*0
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
4'No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
kNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes CNo
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes N(No
24. Does facility require a follow-up visit by same agency? ❑ Yes O'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes kNo
Rio vela igris:or defcien. rtft thls'visit; Yoif :wi11-tee iye Rio ;fit -t r: .
.. eoryesnonde' e' ah" * f this visit ............. .
3/23/99

Facility Number.-O = 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
9No
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,
El Yes
kNo
roads, building structure, and/or public property)
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
KNo
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
gNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
5�No
32.
Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover'?
❑ Yes
KNo
Additional.Comments and/orDrawings*. AL
3/23/99

II
kM
k
U Division of So" and Water Conservation [] Other Agency
54
Division of Water Qualityr"'
WRoutine O CotnDlaint O Follow-up of DWO inspection O Follow-up ofDSWC review O Other
Date of Inspection �--SJ'
Facility Number Time of Inspection 24 hr.hh;mm)
Registered [3 Certified 0 Applied for Permit #Permitted 113 Not O eratic►nal Date Last Operated:
Farm Name:.. ....., 2�].il>P.17f�!iti-.. County:s�...
J... ... ................ ...... ....... lecJ.,.
Owner Name: TMr� 71.E .FOP .�. ........................... Phone No:......�,1�...1.%„Z....................., ......
Facility Contact:.... All. 1�...................................................f
f?. ......y,-1..'f�.l�?.......... Title:... ... ... 21,................................... Phone No:
'/
Mailing Address: M. /M �✓it� /. !1% ...................... .�. ...........................................................
�1�........................................ .......�.�.......� .
Onsite Representative: ............................ ...... Integrator:....... . . .jwl ...
[......................................... >� .. 6...........................................
Certified Operator�.�,?g--a' ..... :a. W ...................... Operator Certification Number ..........................................
Location of Farm:
Latitude 0' ' " Longitude • 6 it
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes i No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0 No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ) ❑ Yes i54 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 ANo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes tgNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes A No
5. Does any part of the waste management system (other than lagoons/holding ponds) require XYes ❑ No
mai ntenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes gNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P No
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes PkNo
Ntructures (LagoonsXolding_Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes J4 No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
~~��
Freeboard(ft):...........,1.-.7...............................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
RNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
R No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
RNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
P_No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
10No
(if in excess of WNW, or runoff entering waters of the State, notify DWQ)
15.
Crop type:.e., ...........................................x....................... ...................... ...�.........
................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
PNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
2jNo
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
IgNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
'O No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified ar Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
P_No .
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(R No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
[ No
0, No'viQlatiOnS"l)Y dificiencies. were: noted,durin� this;visit.- Yo'114 ll. i-eceive:i iil rrher :.
corresO46de00 A out this: visa:
�'%, (� N c>f � � 2i►�� , � S �r>�j ��-lie y PR5 �✓ens .�sf� t� ���2 �A.J.Q.�4�,
(-c7,.,y� a. c.-f — '�� 5 -fir � � o �'.� = u. .�'✓ �i SS - 5 `�. c ��s�.5 a� GS��.�-,. s'-
�.vv' re -[A
I22. A)i<j:) TO kzSe 9,e lz 7_ o'ys LACr'c>rV Z.cwt " 50i4r ZuL,,te95
r- A G C rAQ fn n fJ pt'9(t..5 6V FGL 7/25/97
Reviewer/Inspector Name R =: .�l. ," .. Reviewer/Inspector Signature: Date: — �_

r}�
n[] DSWC Animal Feedlot Operation Review
F.'R A31)WQ Animal Feedlot Operation Site Inspection t
'Routine O Com laint O Follow-up of DWO ins action O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered 0 Certified © Applied for Permit PI Permitted [J Not Operational f Date Last Operated:
Farm Name: ?.1 :1z1 ,�1�j P... 2 ...................... C,ounty:.....(,�✓l!S.Coe,•r.............................................
..... ........................
Owner Name:... . .................. �� Phone No:.........5147....7--M......................................
Facility Contact: j,rq�rR.. .,.: ... 1�!`p2A. Title:.,.A."IfA 11k ............................... Phone No:...,......,.....................,.,.....,.......
Mailing Address:.... �..421.................. r) �7,n.. l� ti��`£..................,...... ....,�..,�,.15AMM..�'.-e4r—........................ .ZsS�f.V....
Onsite Representativer�... .............P........................ IntegratEyr:�7Q�Cj.1�!�r.......,..........................,.............
Certified Operator;......L7..r�,R. iQ.... 'J.............J. ....................... Operator Certification Number-,.,( —z 4,.f
Location of Farm: `
Latitude 4 1 " Longitude • ` 0"
.. Design Current
Swine Capacity Population
❑ Wean to Feeder
EgFeeder to Finish
&44CV
❑ Farrow to Wean
❑ Narrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
se
Number of Lagoons / Holding Ponds JE1 Subsurface Drains Present 110 Lagoon Area ID Spray Field Area
Y ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/inip rove ment?
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-madel
b. if dischargc isobserved, did it reach Surface Water? (If yes, notilj: DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
Does discharge bypass a lagoon system? (If' yes, notify DWQ)
3. Is there evidence of past discharge From any part of the operation`?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[ll(.Io
❑ Yeti
[9-1q0
❑ Yes
GkNo
❑ Yes
UNo
❑ Yes
[B,?( o
❑ Yes
[?No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes �fo
❑ Yes 12<0
❑ Yes [R'Nio:
❑ Yes [BI�o
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes UNo
Structures (I.agoons,iiolding Ponds., Flush Pitsetc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 9,1�o
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....P+C�.!h^*�'�`7....................................•...• .........................,...
Freeboard (ft): .
............................................................. ........ ...•.•...... ... ...... ..............,............... ............ .............. ...................... ....... I............................
10. Is seepage observed from any of the structures? ❑ Yes [�Ko
1 i . Is erosion, or any other'threats to the integrity of any of the structures observed'? ❑ Yes 9'1No
12. Do any of the structures need maintenance/improvement? ❑ Yes [10
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes [±,;lo
Waste application
14. Is there physical evidence of over application'? ❑ Yes IsKo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....Z.A................. ........... Ess.!�!:.:,fir......................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes GKO
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 an -site representative?
22. Does record keeping need improvement?
For Certified or Perttritted 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?
0 No. viol ationsor' deficiencies were noted during this;visit. Nott,will receive no further,
correspondence Al out this:visit.:.
#): Fxplairi-any YES answers and/or any'.
❑ Yes GPgo
❑ Yes R<O
❑ Yes [g'No
❑ Yes E 2f4o
❑ Yes EZ<o
❑ Yes [�Ko
❑ Yes [TI�0
❑ Yes [?<Nb
GKes [o
R�►•rs4aoTr-s�fw, 405;T $�✓r 4�` b` `Vzs
TZ> en
Ff
7/25/97
u
Reviewer/Inspector Name; e , f
•-�
Reviewer/Inspector Signature: Date: