670087_INSPECTIONS_20171231

NORTH CAROLINA
-�
Department of Environmental Quaa

Type of Visit: 91compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: G4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: U Arrival Time: Departure Time: County:
Farm Name: R1� o �� _ _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: BA14 AA
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator:
Certification Number: V
Certification Number:
Longitude:
Design Current
Swine Capacity Pop,
Wean to Finish
Design Current
Wet Poultry Capacity P.
Layer
Design C+urgent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
2
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Farrow to Finish
Dr, P,oultr, C:a aci P,a
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0'-N-o ❑ NA ❑ NE
❑ Yes _❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes �No
❑ Yes jago
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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 ;],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?
(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
;2rNo
❑ NA
❑ NE
❑ Yes
PI�o
❑ NA
❑ NE
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 eNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ZNo
❑ 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 C24
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes hio
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes '[D'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [;30�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2'ICIo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes N ❑ 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 ;dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L2'<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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z�l No NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility umber: - 9T17 I Date of Inspection: III A
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes JZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No P1<A ❑ 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 Fieid ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes P14o ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes�No
❑ Yes Afj No
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 9No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �_ZrNo ❑ NA ❑ NE
Comments (refer. to':question:#)i `Explain `any YES"ans►vers,and/or any additional recommendations or any other.. comments.
Use drawings,of facility:.to better explain, situations. (use additional pages as necessary).
ssce&d �ex�P r.� l�vw.�•-- cn,p4t.d,
Reviewer/Inspector Name: VAIuL t°. Phone: %--[ U — L 3 b t
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

(Type of Visit: &Co lance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
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: j}. D County: 0 SL6l,_J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: RA+wr
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
AM
7 i 5,
■
--
1
1 �` 8�
��¢(4,9., lam;
,��. styi y..e�
'y
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes llJ o ❑ NA D NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Faciii Number: - jDate of Inspection:
Waste Collection & Treatment
4. I� storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: u9
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I7 Y
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 environment 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 6,4c. ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2rNo
❑ 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?
s
No
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
VYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[D"�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ETIN o
❑ NA
❑ NE
Required Records & Documents
VN
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fat to have all components of the CAWMP readily available? If yes, check
ED/Yes
❑ No
❑ NA
❑ NE
the appropriate b .
F71WUP ❑ Check] ists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2fNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes VNo
�No ❑ NA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facile Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Vo ❑ 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 bXo ❑ 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?
ed
❑ Yes P�O ❑ NA [ ] NE
❑ Yes fa ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes [ No
❑ Yes �'10
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
aw; 066069. &S� 1*L.L1 - �-� E� rv► A ��t,� C.E 5.�. �tF E
of Ww5 T 0?06 T� v sz w
Reviewer/Inspector Name:
Reviewer/Inspector'Signatui
Page 3 of 3
Phone4��(�y���
Date:
21412015

Type of Visit: SKom liance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: QrRoutine O Complaint 0 Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Emalz I" l='Cac- L.l-/ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I� 06�'_
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Plop. .
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,uultr,
C*a acit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o ❑ 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 ❑ ❑ NA ❑ NE
❑ Yes �FNo
2 ❑ NA ❑ NE
❑ Yes 0 NA ❑ NE
Page 1 of 3 21412015 Continued

FaE!ii Number: - Date of Inspection: ,S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IZNo ❑ 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 Oo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes dNo ❑ 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 �o 0 NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[;rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
E�rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C2r<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L7 'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesF2'N'o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ZrNo
❑ NA
❑ NE
to have all components of the CAWMP readily available? If yes, check
20. Does the faciVex,
Yes ❑ No
❑ NA
❑ NE
the appropria
P ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21, Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
0 NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes �o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of Inspection: 1
24, Dd the facility fail to calibrate waste application equipment as required by the permit? ❑ YesVNo
I ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [DNA ❑ 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 ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes .✓ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes / No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
/
❑ Yes E]'No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes Q W ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B<o
D NA
❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
4e.d""
❑ NA
❑ NE
Comments (refer tage'stlons#.) Explainany,�YkESy ans weyrs�anid/gor:anyadditionahrecominendutionsor any otFier comments
,
�k"t--ki Sis ER i 'w kl �; Ti 5
3
9 1.Ya� .'n�'-Y 4 :k ., - y,1­11
Usedraw.ings of;facal�tytobetteraeacplain�sltuakionsa(use aaaic�ona.paesas,necessary).;
ZA) SCIJ
o�J4/60' EI lig Kee!
Reviewer/Inspector Name:
Reviewer/inspector Signatu
Page 3 of 3
`Jd6Phone ! 1 d-P
b 4
re: Date:
21412015

Type of Visit: O =0utine
Hance Inspection U Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: #01
Arrival Time: � Departure Time: County: �/$�,p�„� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: B(LZ"-V Integrator:
Certified Operator:
Certification Number: ! 52 6
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Wean to Finish I I Layer 1 11 Dairy Cow
Wean to Feeder I INon-Layer I Dairy Calf
Feeder to Finish RZ 10 'Z, 'a Dairy Heifer
Farrow to Wean Design Current Da Cow
Farrow to Feeder Dr, P,oultr, @a acit Po P. Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
O—ther Turkey Poults
Other I JEJ 10ther
Discharges -and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [] NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ o ❑ NA ❑ NE
[—]Yes o ❑ NA ❑ NE
❑ Yes [ rNo [] NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection: Ip
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q ❑ 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
❑ NA
12 N/No
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [Z/No ❑ NA FINE
maintenance or improvement?
Waste Avolication
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
WX, ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o ❑ 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 g 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Numb r: IDate of Inspection-.__
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesVNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes�`No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage fond ❑ 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 Ko ❑ NA ❑ NE
❑ Yes [5'No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
[:]Yes [31 o ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
i
N ❑NA ❑NE
o ❑NA ❑NE
Comments {refer to question ft -Explain any YIDS answers and/or any additional recommendations.or any other comments.
Use drawines of facility to better explain situations (use additional pages as necessary).
u4f6 OwdER �Ao WUf
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: o , 306
Date: hV
21412014

Type of Visit: m Compliance Insp tion 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: ZmLA Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: RCX W A LS-b Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
EE
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
De. P,oult ,
Ca aci
P,o �.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
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 ❑ NLn❑ NA ❑ NE
❑ Yes YNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Nu ber: - Date of Inspection: 3j,9Lijjq
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2
Identifier:
Spillway?:
Structure 3 Structure 4 Structure 5
❑ No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
Designed Freeboard (in): �(�Q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
16 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o
❑ NA
0 NE
8. Do any of the structures lack adequate markers as required by the permit?
O Yes
YNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3/No
❑ NA
❑ NE
maintenance or improvement?
/No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN F] 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
,No
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [D N ❑ NA [] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes VNo ❑ NA [] NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes d/o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
eNo
❑ NA
[]
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ No
❑ NA
E(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
❑ No
❑ NANE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
&NE
Page 2 of 3
21412011 Continued

Fasili Nu ber: - Date of Inspection: 3011iq
24.JDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA 7 N
25: Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA LtfNE
,'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? ❑ YesVNo
o ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA F31NE
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 2/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
[;ryes
[—]No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�o
[3 NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
WNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�j(No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:'
Use drawings of facility to, better explain situations (use additional pages as necessary).
NoV �6 ['4 NOT 1Jb7r � j -ZLN CC--t`��fZ EFg�AR49,
3a J
CDnnPL,4LT JY ' PQ0Ji CoSSTC L,( FuMID=P� G, �Zc uc>s Vd 3ILo FILL-os
0 uLc M0 V G LC W7 C.a do> =--T:W .J N s-rANa sc��, w>A SrE , OLI W I .*I•/
Sam sLT, ow gx" coo OFF,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: %
If
Date: ia t A
Z14/2 rr

Type of Visit: 0 7Routine
pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit: Fv/9-3 Arrival Time: IS�� Departure Time: 1 /00 County: dk/1,6k/ bin` Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative: k1_r 1'�r-�'
13RU a(, Integrator: 1�
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: - Latitude: Longitude:
Design C+urrent
Design Current
Design Current
Swine Capacity Pap. Wet Poultry E
Capacity Pop. Cattle
Capacity Pop.
Wean to Finish Layer
Dairy Cow
Wean to Feeder
Non -La er
I
I
Dairy Calf
Feeder to Finish Tbero
Dairy Heifer
Farrow to Wean
RDesign Current Dry Cow
Farrow to Feeder Q —nyj Ptoultr
Ca aci P.o P. Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts
Non -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 CZ'/No [] NA ❑ NE
E] Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[3Yes yNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - 87 Date of Inspection:
Waste Collection & Treatment
4. Is storage. capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
�Yes No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
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 N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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
VVNNj
❑ 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
N
❑ 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
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑OthP':
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 V120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1V
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
la o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25.71s the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes N o ❑ NA ElNE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[] NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
No
❑ NA
❑ NE
Other Issues
INp
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
] 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
/No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
F❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain 'any Y.ES answers and/or any additional recommendations or any other comments. <<
Use drawings of facility to better explain situations (use additional pages' as`necessary).
rGl�-?►/1-� t.
•
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C IIDM,-13 VP
Date:
21112011

Type of Visit: (D CQ 'pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z. Arrival Time: ® Departure Time: ® County: lllvJ� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 90_�PT 1►'r'faEGI, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification !Number:
Certification Number:
Longitude:
Design Current Design C*nrrent
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cat#le
DairyCow
Design Current
Capacity Pop.
Wean to Feeder[..-_INon-L4yer__
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design C*urrent
D Cow
Farrow to Feeder
Farrow to Finish
Dt; Poulkr, Cacit P.o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Turkeys
Other'Turkey Poults
Other 10ther
Beef Brood Cow
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes f2i No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [-]Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 fNo ❑ 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 L'J '� o ❑ NA ❑ NE
maintenance or improvement?
Waste Ayplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
ff No
❑ NA
❑ NE
❑Yes
F(Nj
❑NA
NE
❑ Yes
[No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
61eo
❑ NA
❑ NE
❑ Yes
c
[3 NA
❑ NE
❑ Yes
fN o
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 9�0
❑ 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 Condnued

Facili Number: - Date of Ins ection:
24. Did theofacility fail to calibrate waste application equipment as required by the permi . ❑Yes °
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ID Yes WNN60
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
C] NA ❑ NE
❑ NA ❑ NE
❑ 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 o [3NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VNo ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document []Yes ZNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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
ONo
❑ Yes
❑ Yes
eNo
No
❑ Yes
io
❑ Yes
24,
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [24No ❑ NA ❑ NE
(Comments (refer to question ft Explain any. YES answers and/or any, additional recommendations or any other comments. I
Use drawings of facility to better explain `situations (use'°additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
it° (✓ Phone: C.7/ajX _713k
Date: -1/'t/
2141201

Type of Visit: a Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
2eason for Visit: C5 Routine O Complaint () Follow-up Q Referral O Emergency O Other 0 Denied Access
Date of Visit: f Arrival Time: Departure Time: , rn County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
OnsiteRepresentative: Qar;;jf /Lj���EL'U Integrator:
r
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine C•apaciity Pap.
Wean to Finish
Design C►urrent
Wet Poultry Capacity Pop.
La er
Cattle
DairyCow
Deslgn Current
Capacity P.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design Current
Dr, P.oultr.. C*a aci P,o ,
Layers
DairyHeifer
D Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]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
❑ NA
[3NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
VN
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued
Y.

Facility Number: iv - Date of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'S 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ' ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes to ❑ 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
49
maintenance or tmprovemen .
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C�J No ❑ NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E2"No ❑ NA
❑ Yes � ❑ NA
[:]Yes To ❑ NA
❑ Yes
❑ Yes
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
the appropriate box.
❑ NE
❑ NE
❑ NE
El"No ❑ NA ❑ NE
❑' Vo ❑ NA ❑ NE
�No ❑ NA ❑ NE
�Zo ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EJ44o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: f, - Date of Ins ection: jr, lVil
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA [3 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fo ❑ 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? ❑ YesE�Xo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 2No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EJ/No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 12` to ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendatioifs or any otherecvmments: E- _ 1 a
Use drawings of facility to better explain situations (use additional pages as necessary).
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phonk q(V 16
Date:
J

Type of Visit (y�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other , / El Denied Access
Date of Visit: 13 1 Arrival Time: ® Departure Time: � County: OAIft6/V Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: I Phone No:
Onsite Representative: 8JZ x►y zllu I, Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =' = Longitude: = ° 0 ` = «
illllllilillllll ISO
Design
Swine Capacity
Current Design Current Design Current
Population Wet Poultry Cappcity Population Cattle Capacity Population
❑ Wean to Finish
Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
Feeder to Finish
Dry Poultry
❑ Layers
❑ Non -Layers
❑❑Beef
Pullets
❑ Turkeys
El Turke Pouits
❑DairyHeifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
Feeder
❑Beef Brood Cow
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Other I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
ElYes
C7 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
❑ NN
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

facility Number: &7E=1 Date of Inspection
Waste Collection & Treatment
. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S'j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental h at, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes10 El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /1
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application, ,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ILI No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �Zo ❑ 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 10 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ll 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 IVo ❑ NA ❑ NE
Comments (refer tq`xgacstiogn'#):explain any Y1JS.eanswe.rs and/or any recommendat�ans or; any other comments.a g `
Ui'e drawls s�'' facilit to better' x lain situations. use`add�tiorial ayes as necessa
g Y P ( �p g ry).
T
Reviewer/Inspector Name fi i a °' ' ``"fit ; t "
t�.. Phone: D (—
. 6✓*
Reviewer/Inspector Signature: Date:
Page 2 of 3 f 12128104' Continued

acility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box, ❑ WUP ❑ Checklists ❑ Design 6 ❑ Maps ❑ Other
❑ Yes
2 N
❑ NA
❑ NE
ElYes
No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,,—, �LN"-o
& o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El N
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
L
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Zo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O No ❑ NA
❑ NE
and report the mortality rates'that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P<o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
by
31.
Did the facility fail to notify the regional office of emergency situations as required
❑ Yes
2 N ❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
a
Page 3 of 3 12128104

97
Type of Visit ,C.,00 Pliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit CJ Routine O Complaint 0 Fallow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 3 1, oq Arrival Time: C1(a Departure Time: County: G^fSt -oL._, Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone No:
Onsite Representative: 114"01-T _h&.=r.L44t=tom Integrator:
Certified Operator: I Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = f = I{ Longitude: = ° 0 ` 0 "
Design Current
Design Current
Design Current
Swine
Opacity Population
Wet Poultry @apa.city Population
Cattle
Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La cr
❑ Dairy Calf
® Feeder to Finish
b L
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
La
❑Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
10 Other I
INumber
of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
O'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

[Facility Number: 61 — g? Date of Inspection � L►
s Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
6 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: LACky3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4A)
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El"No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
E3/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 ErNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U/ No ❑ NA ❑ N E
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes [?f/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
t 0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 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,�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
lJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ONNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
."h.'i.c:. '*� �'v $ y "A."Y��.Sg.h ^L.� .,�i` ttV'h'.�.s.� ✓ ro' :' `t. *,R. .aa
Comments ((refer t.o uestidn # Ex lam an YES answers and/organVfi ecommendattons organ other cowm�ment
.ry q:>. � � -.,J � - .... s.w, jy� $^�'r r ���
`Use druwmgsFo! t.tcility to better explain tiituat�ons (ns� acldihonal pages>as necessary} .
L
Reviewer/Inspector Name �- -� _. f'+4 -� Phone: nl a G --
8
Reviewer/Inspector Signature: Date: 3< t► o 9
Page 2 of 3 12128104 Continued

�A
Facility Number: 60 - $ 7 Date of Inspection
1
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement'? if yes, check the appropriate box below.
❑ Yes
❑ Ko
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
PlAnnual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B'-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
07No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q-No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E: NNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
eNo
❑ 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
t'J 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
C
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[a'fio
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[/No
❑ NA
❑ NE
Additional Comments and/or Drawings: - .-
Page 3 of 3 12128104

6P
Type of Visitpliance Inspection Operation Review Structure Evaluation 0Technical 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: 1GOW Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: Q&E.l�t %V�"rt`��L-� Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 4 = d = Longitude: = o = 4 =
Design
Curreut
Design Current
Design
Current
Swine Capacity
Popula_..tion
Wet Poultry Capacity Populatinn
C*attle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
19 Feeder to Finish
S 7_$D
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultty
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
Turkey Poults
❑ I
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El
yNo
NA
El
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — T
Date of Inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure Structure 2 Structure 3 Structure 4
Identifier: AraADIf
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan'?
❑ Yes 5 Na ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes In ❑ 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 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo
El NA [I NE
maintenance/improvement`?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Ellyes
❑ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?❑ Yes
.O'N ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
�Zo❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1 S) W (= (___0 Co ►rC'Gt,ocr C rJ b
Reviewer/Inspector Name "_-ro Phone-
Reviewer/Inspector Signature: Date: I 6�
1 12128104 Continued

Facility Number: 7 — Date of Inspection d
'Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ElNA
ElNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesFNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [3 Maps ❑Other
/No
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[I NA
[I NE
[I Waste Application El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [I Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspectio�Xplo
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facilityfail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NA
❑
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
6
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J7N
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PEAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N
[I NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[IYes
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
OJ 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
W 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
NkNo
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
AdditlonaI;Cojntnentsand/or Drawings ` `" �. s t,A '.":tt
�` `�, , `1K �t..i':�
'`.t`° k t? �:., Ir
A
Page 3 of 3 12128104

Division'of Water. Quality
�TfAdlity Number: �] ,� �Y_ o Division of Soil and. Water Conservation
- 0 Other: Agency
Type of visit
Corr>yfHance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: b o i Arrival Time: O Departure Time: County: 00SLA I - Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: QN �Y1�TGN L
Certified Operator:
Back-up Operator:
Location of Farm:
Design
Swine- Capacity J
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Latitude: =
0
Integrator:
Operator Certification Number:
Back-up Certification Number:
" ,
Longitude: 000' ❑
urrentDestgn.Current--"Design,' Current
elation ;Wet,l'oultry, Capac>ity,::.Population Cattle1, Capacity. Population?;
I'.ILJ Non -Layer I I I
Dry Poultry
❑ Layers
1. ❑ Non -Lavers
JU Boars I I
- ' ❑ Turkeys
Other 0 Turkey Poults
❑ Other El 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?
❑
Daia Cow
❑
Dairy Calf
❑
Daia Heifer
❑
Dry Cow
❑
Nan-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
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?
Page 1 of 3
❑ Yes 3No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El No [I NA
❑NE
El Yes
❑ Yes
N ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection
aste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structur 1 Structure 2 Structure 3 Structure 4
Identifier: 1-4 (s
Spillway?:
Designed Freeboard (in): a�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ErNo ❑ NA ❑ NE
❑Yes ❑No El NA ❑NE
Structure 5 Structure 6
❑ Yes rJ No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes rNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 12NO ❑ 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 El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C 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 2No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑No ❑NA ❑NE
ONo ❑ NA ❑ NE
E No ❑ NA ❑ NE
21<0 ❑NA El 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):
(=LJ G EOWZ. ��;V 1�13� izi LL: iN L .�� tk(�p "A SI A i, .
'
Reviewer/Inspector Name 1 0 �� 1 Phone: ..
Reviewer/Inspector Signature: Date:
Page 2 of-3 " 12/28/04 Continued

Facility Number: (7 — Q Date of Inspection I s 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 Bl1 o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
214o
❑ 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
Q.NV
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑Ko­
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ETNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑dl-o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�rNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EVNZ ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E "o
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,,����
L<No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
B o
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑4<o
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
I/J No
❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

'Facility Number (� 7
i
Division of Water Quality
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit Qtomp 'ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I H f } JO k I Arrival Time: © Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: —
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: QfUA/r 14-LT C,4 W- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =' 0" Longitude: =° [=]' =
Design Current: Design. Current Design, Ct>Irrent
Swine Capacity. '1Population: Wet Poultry 'Capacity Populziltion Cattle . Capacity Po"pulation .'
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish ,$' Z6D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars h
Other
❑ Other �.
❑ Layer
❑ Non -Layer
I
Number of Structures: '
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
❑
Beef Stocker
Beef Feeder
❑
Beef Brood Cowl
I
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
12128104 Continued

.j Facility Number: &7— '7
Date of Inspection D Obi
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: 6 W
Spillway?:
Designed Freeboard (in): !�V
Observed Freeboard (in): �A
Structure 4
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalth
❑eat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes Eo ❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? [I Yes rJ 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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 2 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) 66A) S 6 7?
13. Soil type(s) 6,01.i &/& ,4 C,1Lk
14, Do the receiving crops differ from those designated in the CAWMP? ^❑ es
15. Does the receiving crop and/or land application site need improvement? LI 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
No ❑ NA ❑ NE
El ❑NA El NE
o ❑ NA ❑ NE
L'�Nv El NA ❑NE
l,d'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 add itiona f pages as necessary):
20). CIPPAi6 k4e SEA.,V 1a 0 Q
1 s) W�6,0 0A11_XXfi. AlE 1 p Q9, c, yt� NE f��11 f)&kn tAst 5006 S&rL(
Reviewer/Inspector Name 0 7�/V��- 1 Phone:
Reviewer/inspector Signature: Date: y 3 Q
Page 2 of 3 / 12/28/04 - Continued

A
r
Facility Number: &Z— 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 omponents of the CAWMP readily available? If yes, check �es ❑ No El NA ❑ NE
the appropriate box. p ❑ Checklists ❑ Desi n ❑ Ma s ❑ nth-
5
p
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
,.,//❑
E7 NN
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
LJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E(a
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
Ir,NNNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LAN
❑ 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
LS N
El NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�,�
[2�N/o
[I NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
i
T
Page 3 of 3 12128104

G1 H 87
Type of Visit Qf CC pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �� Arrival Time: /03p Departure Time: County: Cll�>5L-6k/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: M�L1S,, CAU P%O AJGrjj Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 4 = Longitude: = ° = 6 = N
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑
Wean to Finish
❑
Wean to Feeder
®
Feeder to Finish
cs
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Nan-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
El NA
❑ NE
El Yes
YNo
❑ NA
❑ NE
12128104 Continued

Facility Number: &I — 1
Date of Inspection dG DS'
Waste Collection & Treatment
4.'js 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: H C. r
Spillway?:
Designed Freeboard (in): Zg
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?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA El NE
❑ Yes 0No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I[J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes dVNo
❑ 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 [I Yes ❑ NA ❑ NE
maintenance or improvement?
Waste A lication
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 In 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 Drifl ❑ Application Outside of Area
12. Crop type(s) REam m, L H SGO
13. Soil type(s) Q.1L "-; , 2O
14. Do the receiving crops differ from those designated in the CAWMP?
ElYes
[(No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination"❑
Yes
�dNo
LI No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
dWNo
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
al.) fnoyr va 10s9EGTLc4� Or t.-@Iflauni vjALLZ +>:0-44 I" ofL rAo(Lk tRA5:r4 fl.�A+—l.
OPIA-TC, CR4e `Is'Ec.p Irorzr..l,
V a4v., L,001e S Coop,
ao) WOP it�p.s LROATE '0 +� � Ap1P FGrL 5Gb f M0'� -c4 4 '-c�1
Reviewer/inspector Name ~T aV &I, , i '", 7' ': ` Phone: ��i9Sd0 k ZZ
Reviewer/Inspector Signature: Date: o
17/7AN1Q f ntilis��ioii

Facility 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.
components of the CAWMP readily available? If yes, check
Does the facility fail to haVWUP
/yes
El No
[I NA
[I NE
the appropirate box. ❑ Checklists ❑ Design El Maps ❑Other,
21.
Does record keeping need improvement? If es, check the appropriate box below.
p g P Y
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wee ly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
"
❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections Monthly and 1
Rain Inspections
❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
DN/o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
DNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit`?
❑ Yes
[_�,, N/o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pen -nit?
❑ Yes
E o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
!
❑ 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
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
ETNo
❑ 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
V 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
9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LJ No
❑ NA
❑ NE
Additional: Comments and/or Drawings:
12128104

)3fermitted [3Certified © Conditionally Certified 13Registered Date Last Operated or Above
-T-hrr hold: .........................
FarmName: ......... 4................�.......................... County:.......11f�....w..................................... ..........
OwnerName: .................. ...... Phone No: ............................................................... -......................
MailingAddress: ................. ................................................................... . .............................. ..................................................................................... ..........................
FacilityContact: ................................................................_............Title:...................... �,� .. Phone No:...................................................
Onsite Representative:.1 .........::..1......�'rf�ir%r.. ....L..:.1K..Un I gr�.....................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude " Longitude • ' "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
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 P(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes /NO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: ................................... ................ ................................................................................................................................................................
Frecboard (inches):
12112103 Continued

Fa ' ity Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [XNo
seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes �No
❑ Excessive Ponding ❑ PAN Q Hydrqulic Overload ❑ Fro;en Ground [].Copper and/or Zinc
13. Do the receiving crops differ with those designated in the Certified Animal Waste Nfanagement Plan (CAWMP)? ❑ Yes Y No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes )zNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? Yes ❑ No
16. is there a lack of adequate waste application equipment? ❑ Yes P No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes f fNo
Air Quality representative immediately. /
❑ Field Copy ❑ Final Notes
P,2) 1.1op 1,t�A✓Ooco 5 %R %,�4*Vl/j4 6vo min 6-.ee4o1v /Z/E� o l
3�ZfS3/10_;tt P01
O�
15) IV6 o s� 1�*65 F :�,
Zcf 7*e6^)57
Revieweranspector Name et �
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: — g Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes WNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes XNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VrNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ZNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes VNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes /No
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes YNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes ZNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
Zlyes ❑ No
3I.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes XNo
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes PrNo
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes ONO
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes gNo
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
, Yes ❑ No
❑ Stocking Form 'XCrop Yield Form ❑ Rainfall Inspection After 1" Rain
,0120 Minute Inspections []Annual Certification Form
12112103

Type of Visit to Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: / 0 Time:
Not Operational Below Threshold
Permitted O Certified © Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: County:
Owner Name: 22&k/¢� , _ Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: ; ETC Integrator: br "' 92- D�P� _
Certified Operator: Operator Certification Number:
Location of Farm:
O Swine []Poultry []Cattle ❑ Horse Latitude ' • u Longitude 0 1
Current "i ' 3 33°'i Design I�l_Current �i�'' E 'Destgn Current
'""]
Swine Ca actty: ,Po ulatton :;'`'.Poultr Ca^acitr."Po ulatton: Culation _ .>>
❑ Wean to Feeder ❑ Layer ;''E ❑ Dai
Feeder to Finish ❑ Non -Layer i ❑ Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder ❑Other
❑ Farrow to Finish Total Design'Copacity'
❑ Gilts
❑Boars..>> IzF.`. Tt►taI S LW iR
Number of La{ryowns ❑ Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area P
Holding--;Ponds'f,Solid Trapsi ❑ No Liquid Waste Management System�'�'
Discharges & Strcam Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): .142
05103101
❑ Yes $ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
[ No
❑ Yes
WrNo
❑ Yes 'XNo
Structure 6
Continued

Facility Number: —g Date of Inspection 0 2
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
A�No
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
❑ Yes
; No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
0No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
9No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
X No
11. Is there evidence of over applicatio ? ❑ Excessive Ponding ❑ PAN Hydraulic Overload
❑ Yes
ILJ NO
12. Crop type IJDA[
I3. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ANo
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
No
Reguired Records & Documents
IV
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ANo
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
ANo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
ElYes
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
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
9No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
X.
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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comineatsc{refer tn;question #) Eicplatn a"n`y YES answers:and/vr'an} recommendations or anv other comatents.
Ilse clrawtngs of facility tp better explain situati6s,.4use additional pages as necessary)- a
11 ❑ Field Copv ❑ Final Notes��'
,.
I� zeln�Dg � o u/.� f STD �s-�n7o.��v F�
���Pinc/JFi 1`'iPES ✓r Git/ Smears Gb,7,7,r� e ✓ Fz,Lp,
�T���iPS � ��iQ`,9,Qsi►�, �v��D /�����i S �CQ,� �L,•�rd��
l�fr P
Reviewer/Inspector Name
Reviewer/Inspector Signature: / Date: /
05103101 v' Continued

Facility Dumber: — Date of Inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [:]Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt. ❑ Yes Q{ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or ////I
or broken fan blade(s), inoperable shutters; etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes N0
32. Do the flush tanks lack a submerged fill pipe or a perrnanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or,Drawings:.,i: 0r
�
Fes- �Doz.
TC�/i7 �/-Ganr+� G DliJG/1 rll;lj
T
05103101

to
Q Other A7 ...
Type of Visit © Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint O Fallow up O Emergency Notification Q Other ❑ Denied Access
r Daie of Visit: 4-5-Z1101 Time. 1215
Faeilit�• Number b7 87
,r« 0 Not Operational 0 Below Threshold
Permitted 0 Certified E3 Conditionally Certified C1 Registered Date Last Operated or Above Threshold:
FarmName: HC.Eat'.tptc..................................................................................................... County:
Owner Name: Mark ............................ i .&Y.Auaugh.................................. Phone No: 9J.D-_324.:2,GUG .__.-- -- -- -- -
Facility Contact: _ _ _. -.._ __ __ __ __ __ __ ____ __ __ __ Title:. __ -_ ._ . Phone No
MailingAddress: P.Q.BAR&.398............................................................................................ RacbJaztd&.NC....................................................... 2857.4 ..............
Onsite Representative: ir�Ak. ........................... Integrator: GQ1dsbAGp.HagXar=..............................
Certified Operator: Mark- .. .. .. .. .. ........ CayADwtgb_ -.._ _.._ ....._ ._ Operator Certification Number: IL235
Location of Farm: .
West of Richlands. On South side of Hwy 258 approx. 1 mile West of 258/24 split. Entrance is across from SR 1300. +
® Swine ❑ Poultry ❑ Cattle ❑ Horse
Latitude f���34�M • ��55 �'_.� ...25������ Longitude ,...77 �� • �•36W -lb���
Dicchar�es S Stream Impacts
1. Is anv discharge observed from any part of the operation?
_ ❑ Yes 9 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. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ED No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway F9 Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..... _.. _.. _.. _.. _.. _...... ......... _.. ........................
freeboard(inches): - -- ---yf'-- -- -- -- - -- -- - - ---- -- -- -- -- -- ------ -- -- -- -- -- -..- -- -- -- -- -- -- -- -

t,'onnnued on back
y Nomber: 67 —87 Date of Inspection 4-5-2001 Printed on: 4/25/2001
t.herc any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
;d pre there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes N No
❑ Yes ® No
❑ Yes ®No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? -
16, Is there a lack of adequatewaste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
No violations or deficiencies were noted during this visit. You will receive no further
correspondence about this visit.
® Yes []No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes 0 No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
tote: This inspection report was modified from original left on -site and will be sent to Goldsboro Hog Farms for their records i
nd to provide a copy to the grower. r
$ & 22. According to lagoon design, the required freeboard is 28". Estimated the level to be 26" since no gauge markings
Nere visible. Marker was confirmed to be correct and accurate by George Pettus of Goldsboro Hog Farms on April 23.
according to Mr. Pettus, the first marking or peg is at 28" and no pegs were visible during inspection, thus lagoon had
nadequate freeboard. No enforcement was or is being sought due to the fact that there was some confusion over the
'equired freeboard by the design. Continued on Page 3
ReviewerMspectorName DeanHuakel�.:::

I
AllspeCLUr alguature:
Lillie'.
5100
r
�' Number: G7-87 Date of Inspection 4-5-20I11 Printed on: 4/25/2001
sues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 0 Yes 0 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 R No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged till pipe or a permanent/temporary cover? ❑ Yes ® No
& 22 Cont.
nce lagoon was in the red with inadequate freeboard, the grower was required by his General Permit to notify DWQ
rich he failed to do. This event serves as a warning and future instances will be cause for enforcement. Grower needs
be provided with a marker design.
5. All fields needed substantial improvement except field on far side along Hwy. 258. Concentrate applications on best
eids until June and mow poorer fields until then without applying waste. This should help improve field by reducing
ompetition and allowing bermuda to spread. Aeration or straight disking fields would also probably help as well. Apply
me by this fall as needed. Drainage improvements as farm should also help.
ote: Recommend having waste plan revised to add overseed as optional on any field/pulls as long as minimum is
anted and strive to obtain maximum freeboard by end of September to limit need for as much overseed. Basing plan on
ills would be best.

Division'of Water Quality
Q Division of SOl18nd rater CORSeI Vat3onF • f.� -t �E I a #. {'�E 3€iei ,,�( l ;,, ,, j i i�+F
O.OtherAgepey
' ..I _ , , ,tE��, F 4i' E , Sit„� � '��1 0,�o JAI
Type
Type of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit P Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date. of Visit: Time: E= Printed on: 7/21/2000
Q Not O erational Q Below Threshold
Permitted 0 Certified J3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: .... r.: 1'� �. s.............. County:........ 5.1�!......................................................
.` ....
OwnerName:........................................................................................................................... Phone No:.......................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ..................................................................................................................... ............................................... I........ ..........................
�7 t tt
Onsite Representative:!�-e.:...�...Pv„-�.. �1................... Integrator:.....�2tf�3......�................................................
Certified Operator:................................................................................................................ Operator Certification Number:...............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude e 6 0`4 Longitude • 6 66
Design Current
Capacity Population
Wean to Feeder
Feeder to Finish
0
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
Gilts
Boars
i Numbei,gf Lagoons
Heldiug fonds / Solid"Traps
Design Current Desi<ga; Curre"
PoultryCapacity Po ' ulation Cattle
1. Ca Brat . `Po `ulatlon
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other �
Total! Designs Capacity
Total SSLW'`
La non Area Spray Field Area
Subsurface Drains Present ❑ g ❑ p y
T
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
K If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 1� No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
Yes �(No
Structure 6
Identifier: .................................................................................................. .............. ........
Freeboard (inches):
5/00
Continued on back

)Facility Number: — Date of .Inspection Printed on: 1/9/2001
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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding [I PAN ❑ Hydraulic Overload
12. Crop type YDa ✓v,,,-F1� 4� V'ci�-. n VQ-5-4-ed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does thefacility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Regui,red Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NQ-yiQl'a> 00s'ot- def eien0o -Wore jnoted• iloiog Ns:visit;, Yoo Wiil•�eeeiye ti turthgr ' '�
. • eoriesDbndence: aback this visit: • . • . - : - ......: � : � .....: - ..... � :....: . ...... .
❑ Yes *o
❑ Yes )Rf No
❑ Yes J4 No
❑ Yes VfNo
Yes No�
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
Yes ❑ No
❑ Yes JR(No
❑ Yes 0 No
❑ Yes ONo
❑ Yes No
❑ Yes No
❑ Yes XNo
RrYes ❑ No
❑ Yes 29 No
❑ Yes ZNo
❑ Yes XNo
Comments (refer to nests ` ' mmendations or'any fltlter comments.
Use' dra of facili to%titter ex lain, situations: (use 'addthonal pages as
q on . • Explain atn any YES answers.ae or.any reco
U "arrngs, ty . P P $ necessary) i
Ll �0> _. A.
-
�„r�ts-� -� c��'� 5� t.-.Q,e,� Mkt, � -eX� `►� -�" Cct�+�ec-�-d .
�� Ce�--.,z.t--,� ��,�►-`ter. ` �
Reviewer/Inspector Name, ri 1 1 �' + S < } i �t ! } , ;! e C z , ! ' .3 ...
Reviewer/Inspector Signature: Date: —'S—Q ( 5/00

:Facility Number: g Date of Inspection _�/. G� printed
on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
jf 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
0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29. Is the land application spray system intake not Iocated near the liquid surface of the lagoon?
❑ Yes
No
1
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
Additional Comments and/orDrawings:
� S� •�-� � ��et�s �ee� e..� s�s���-�I�� `t t�,�,��eti.r.e�` e.x«p-� �'i �L� c �
rJ
r-c c e, r v !3e i +--� 56 � � het L J'L%�--e
n
v'tL—� L-,r—. 3 +tee► e4
Gllv- C-14 0t (LS l�l' L� 4 kkx+
5100
J

Division of Water Quality
0 Division of Soil ands Water Conservation
3
0 Other Agency
Type of Visit XCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other p Denied Access
Facility Number Date of Visit: ®rhille: ®Pj•intedon: 7/21/2000
0 Not O erational 0 Below Threshold
Permitted © Certified © Conditionally Certified © Re istered Date Last Operated or Above Threshold:
Farm Name: ..... Gy......... .................... C ................... County:..... .'..................................................
l ��
OwnerName............................................................................................................................ Phone No:..............................
FacilityContact: ..........fitle:................................................................ Phone No:...................................................
MailingAddress: ..................................................................................................................... ....................................................................................... ..........................
•Onsite Representative:.,�----0"�tf"�` ............................ Integrator: .... C; L .1.:71.�z...............................................
Certified Operator : ................................................... ............................................................. Operator Certification Number:............................ ..............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �° Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I 1 10 Dairy
❑ Feeder to Finish ❑ Non -Layer I ❑ Nan -Dairy
❑ FarroW to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacks
1. is any discharge observed from any part of the operation?
Discharge originalcd at: ❑ Lagoon ❑ Spray Field ❑ Other
a. 11"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 estimalcd flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway
Structuru I SlrUCture 2 Struc;lure 3 Structure 4 Structure 5
Identifier:........................................................................... .................................................................................................
Freeboard (inches): rb
5/Elul
❑ Yes 9No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes j rNo
❑ Yes �No
❑ Yes )<No
Structure 6
Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes NrNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes N' 40
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ANo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes MNo
I I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes prNo
l
12. Crop type lr, 1 St'1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application'?
b) Does the facility need a wettable acre determination'?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Rec uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NdVo Mafioris;or &flcien6es mere h6fed. diihrig Ois'AsIC - Y;60 wits-f&c Ke iio further • ;
corres' oridence' abbi6f 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):
❑ Yes 9No
❑ Yes C�No
❑ Yes ❑ No
❑ Yes ❑ No
'Yes ❑ No
❑ Yes Wo
❑ Yes JRfNo
❑ Yes jNo
❑ Yes M No
❑ Yes XNo
❑ Yes D�No
❑ Yes 'No
❑ Yes N No
❑ Yes( No
❑ Yes ,P51 No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5/00

)t±acilrty Number: — Date of Inspection GQ Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes J�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 9No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �'1Vo
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 �j No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes rN
o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yeso
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ,KNo
Additional Comments and/orDrawings:
�-
�re� ,
T
5100

Division of Soil and Water Conservation - Operation Review
r
13 Division of Soil and Water Conservation - Compliance Inspection i t
j 9
Division of Water Quality - Compliance Inspection �"
D.Otfier Agency- Operation Review • ".. r
J%Routine Q Complaint Q Follow-up of l)WQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of inspection
Time of Inspection Q 24 hr. (hh:mm)
Permitted D Certified 13 Conditionally Certified © Registered JE3 Not [) crational Date bast Operated:
..........................
FarmName: .... ;T....................................... .... ...... .................................................. County:......�� CJ{................. ............... .............................
Owner Name- -'s ...........................
....................................................... Phone No:.....................................................,.................................
FacilityContact:...............................................................................Fitle:................................................................ Phone No:...................................................
Mailing Address : ................................................. .......
Onsite Representative:...+- , . �,.......1.'.:�1.....``'�. Intei;rator:.........::................�?................,.,.......................
...,
Certified Operator: ................................................... ............................................................. Operator Certification Number:...................,......................
Oil
....".N...1'
1`.,.... P.......Is......r;�.!�T. --,.. ..� G
5r.j.....s ,.. ,.............:............... ....
Latitude Longitude �• �° 0°�
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
$O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I 1 PEOINon-Dairy
Dairy
❑ Non -Layer
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present IJO Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes )?rNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance. man-made? ❑ Yes ❑ No
h. ll'discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of -the State ❑ Yes ❑ No
c. If discharge is observed. what is the estimaled flow in gal/min?
d. Docs discharge hypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes gNo
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes k No
waste Collection & Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes W'No
Structure t Structure 2 Structure 3 Structure 4 Structurc 5 Structure 6
Identifier':
Freeboard (inches): ..........93............................................
...........................................................................................................................................................
l /b/99 Continued on back

_;,I,Fhcility Number:61 — $'�] Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings'?
Waste Application
10. Are there any buffers that need maintenance/improvcmctit?
11. Is there evidence of over application? ❑ Pondim, ❑ Nitrogen
12. Crop type .. ................................................................................... .
I�
❑ Yes 14No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate w1uste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ie/ WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis.& soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -silt representative?
24. Does facility require a follow-up visit by same agency?
1p.
1Vo.vialat►ons •or. deficiencies .were nat�d during this.visii.. •You wilfretceive no, Nd ier.
• cor;resOb idenee; tabotit: this visit.. .. .
❑ Yes 'j No
❑ Yes W No
❑ Yes ZNo
❑ Yes 4 No
❑ Yes XNo
❑ Yes ( No
❑ Yes No
❑ Yes MNo
❑ Yes kNo
❑ Yes [9No
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes 5No
❑ Yes No
❑ Yes PNo
Comments(refer to question #): Explain any YES answers and/or any, recommendationsior,any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): F
h_ : l . a
l`j} ��>•— tF�—j- p►..� 1�� 3• ✓t�ll--� ,�� '�1Q\� \`� -P�� . �1� �-�p'�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
F' •3
Date: 11/6/99'

I
13 Division of Soil and Water Conservation [3 Other Agency
aDivision of Water Quality
ICRoutine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of inspection /� 7 41
Facility Number Time of Inspection v 24 hr. (hh:mun)
©Registered E3 Certified 13 Applied for Permit �*ermitted JE3 Not O erational Date Last Operated: ..........................
FarmName:...... ........ ....�....... C.. .. !!!`.................. I .......... .......... County:..... 4l LAG.............................................
Owner Name:...'e.O4.........................V.d..✓..t..ti/r�,...�/1.�............. Phone No: 2"1..................................
i
Facility Contact: ............................................................................ Title: 4 .w..h: 11................................ Phone No:
Mailing Address: ........:�U.. ' .lv x �J� I L.lL.sy J..........................................2057�
.............................................................................. ............`......... y
Onsite Representative:..t.......4.'.r�iNctc� ........................ I.ntegrator:.......LTl1 r,%�5..4lxz7..............................................
Certified Operator:...., ..Q.................... ... ...zf.=1VA..+.1"..1 . ..... Operator Certification Number:... .....:3
Location of Farm:
Latitude 0• 4 " Longitude rr ' 4 "
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
G. 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 JU'No
❑ Yes (Q No
❑ Yes 4 No
❑ Yes R] No
❑ Yes No
❑ Yes No
JaYes No
❑ Yes Q No
❑ Yes -0 No

Failility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoons,tiolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
......................................................................
Freeboard(ft):..........-3�..........................................................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14.' Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........... --........................................... A...(.........................................I........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
.23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
O, No.violationsor deF.ciencies: were noted-durin� this:visit. Yod4ill i-eceivei '61tirih:er
. ctffrespWebO dliout
A11C WPMC
❑ Yes 4v- No
❑ Yes ZNO
Structure 6
....................................
❑ Yes 0 No
RYes 4®-No
�Jok_.
® Yes ❑ No
❑ Yes Fet No
❑ Yes 4 No
.........................................
❑ Yes JR(No
❑ Yes allo
J Yes ❑ No
❑ Yes fid No
❑ Yes J�J No
❑ Yes ,iNo
❑ Yes ,O.No
❑ Yes ,�Q No
❑ Yes ONo
❑ Yes ,z No
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Reviewerflnspector Name
Reviewer inspector Signature: Date: