310119_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

l
t ype of visit: ® Uompttance inspection v vperatton xeview V structure r.vaivanon V i ecnmcai assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: Arrival Time: I :00 a Departure Time: 21Q0 County: Q U P L.� Region: W" "
Farm Name: � � �' a r.,C.2 17tw en Owner Email:
Owner Name: J Q rr'l S 0 r('CQ Phone:
Mailing Address:
Physical Address:
Facility Contact: V u S t3 f , �u Title: Phone:
I I g rat � 1,C e [ of
Onsite Representative: Inte rator:
Certified Operator: t I Certification Number: 2, 006
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
jDairyCow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
3 14q
Dr. P.auI C•--a aci_ P,o P.
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
jBeef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
:�Jm
Discharges and Stream Impacts '
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
L
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [Z No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [—]No
❑ Yes 0 No
❑ Yes '? No
[:]Yes tp No
N NA ❑ NE
N NA ❑ NE
M NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page l of 3
21412015 Continued

Facili. Number: _ Date of Inspection: Zp
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? [] Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
No ❑ NA ❑ NE
❑ No Pg NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 y *3
5. Are there any immediate threats to the integrity of any of the structures observed? D Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �PNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EpNo ❑ 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 IM No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes rp 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 ! ^_ ❑nn Evidenc f Wind Drift ❑ Application Outside of Approved Area r�
12. Crop Type(s): � ,dr Y1�{.t.tL�'W Cl-VA s� QS Q VQ C PQsl� Si+ti po' v
13. Soil Type(s): 4J@-r4 I `_,9A At 65-ro— -=4 �r�''l �✓
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [P No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes W No ❑ 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
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�j No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(5a No
[DNA
❑ 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
❑ 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: 217 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
[DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes
M'No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
10 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 `P 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 [PNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
j� 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
Eh No
❑ NA
❑ NE
33. Did the Reviewer/Inspector 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
N No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain -situations (use additional vases as necessary).
-3f-I19
31— q Zi - Co"'�'j tj 46ve_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0110--L 3 -334 >
Date: ? 20 1
21412015

n
i ype or v sit: S�ompnance inspection v operation xeview v structure Lvamanon V i ecnnicat Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: j d0 Arrival Time: I1.L.�fJ E Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �{(� r� �pJ Integrator
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder I
Design Current Design C*orient
Wet Poultry Capacity Pop. Cattle Capacity Pop,
Layer Dairy Cow
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Dry Cow
D . P.ault , Ca aci P.o Non -Dairy
Lavers Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
113eef Brood Cow
Qther
Other
Turke s
Turkey Poults
-ElOther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
O Yes 12 No 0 NA ❑ NE
❑ Yes
2no
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [) Yes ;"No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3 "o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued

Facility Number: _ Date of inspection: 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2, Structure 3 Structure 4 Structure 5
Identifier:
Ea'No ❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): pZ y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [D-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 .ENo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ,R�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Lj f 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 2/ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ,❑'Flo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ❑.Pdo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Q No
[DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes &No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 2TNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 'Lg-wNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Vivo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J2-�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other;
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes _C]Ayo ❑ 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 )2no ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JE o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: Y dt
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Er*No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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?
Comments (refer to question #): Explain any YES answers and/or any
Use drawings of facility to better explain situations (use additional pat
• /(!u> /^C cads a----
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
511cAAJ&--Sr
esasn
1-a
❑ Yq,, Vo 0 NA FINE
❑ Yeso ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E]o ❑ NA ❑ NE
❑ Yes, - ❑ NA ❑ NE
❑ Yes �le ❑ NA ❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes -E3-Mb_
❑ NA
❑ NE
❑ Yes J
❑ NA
❑ NE
ns or any other comments.
Phone: 7`aT
Date:
21412015

i ype ut visit: ,V t.ompnance inspection v vperauun xevtew V structure r valuation l.J i ecumcai A%sststance
Reason for Visit: 07koutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: /Q Departure Time: County: Region:
Farm Name: { [r Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: E ck LC z ce Integrator: ! ' 1 4
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pap. Cattle
Layer Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current Dry Cow
D . P■■oul Ca aei. P,o , Non -Dairy
ILayers Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Broad Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b, Did the discharge reach waters of the State? (If yes, notify 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 P-No ❑ NA ❑ NE
❑ Yes ,n No
❑ Yes J ] o
❑ Yes J'No
❑ Yes 4:yNo
❑ Yes En"No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili 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 ErNo ❑ NA ❑ NE
Strucr 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ,�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
[:]Yes [—].No
❑ NA
❑ NE
maintenance or improvement?
T
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes P-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes ❑.W)
❑ 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 ,.EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Eno
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes E�YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 'EE'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes j 'Ko
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZrNo ❑ 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 E]'�Veather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield f1120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes zf�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El"No ❑ NA ❑ NE
Page 2 of 3 214120I4 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JZNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[EfNo
❑ 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
PITNo
❑ 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 file 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? ❑ Yes 7,No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 0 Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 5/No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
Ei No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other.comments... -.
Use drawings offacilityto better explain situations (use additional„pages as .necessary).
Koa 4pi 6L.,-M WmPkeC C-o,
lr'lli l w4 I1 s
Ur-- IC.yor -2-
hat/"?_ 103+
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
f -e L or �r%� G•'1
Phone: [ f
Date:
41l0 4

Type of Visit: �'ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access?
Date of Visit: /O Arrival Time: ; Q Departure Time: ounty:0_1 Region
Z
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title: Phone:
Latitude:
Integrator: VVN, I j?
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design C*urrent Design Current Design
Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity
Layer Dairy Cow
Current
Pop.
Wean to Feeder
I
JNon-LUer I Dairy Calf
Feeder to Finish
20CJ
Dairy Heifer
Design Dry Cow
Dry, P,oul , C•_a aci t ymP,o , Non -Dairy
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
e s
tur,eyPoults
r
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZFNo ❑ NA ❑ NE
❑ Yes ❑/ No
[:)Yes W'No
❑ Yes ffNo
❑ Yes [a o
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: IDate of Inspection: d
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑'No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: ,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ;a 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 JZ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes 2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes E�'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 F�No
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes PrNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Z] No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 J;allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:)Yes P�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ]44o
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes �3No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes EJ o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Wo
❑ 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 ;2,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes .6No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes &No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Iq I
Facility Number: - Date of Inspection: 16
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes .0 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes L?'No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes allo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes �3 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes allo
❑ 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 �jNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
"�o
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ErNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
La' No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any.:additional recommendations or any other comments.;..
Use drawings of facility to better explain situations (use additional pages as necessary).
Y� � �j jA(,->
y�.�3Dtot-t far ss
�y 3
Au
2�,
3 V/y 0-
?f' G� 3
/s 3?
Reviewerllnspector Name:
Phone
Reviewer/Inspector Signature:
Page 3 of 3
E Date
a 3
21 22014

Type of Visit: -cmpliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: d Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 4& � p
T- r
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C*urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cai#le Capacity Pop.
DairyCow
Wean to Feeder
]Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . U1111 Ca aci P■o ,
Layers
Dry_ Cow
Non -Dal
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turkez Poults
FlOther
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)
❑ Yes ,F'No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ,P7rNo ❑ 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 EfNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes dNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0'*No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: 7 1 - Date of Inspection:_ �Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �2"No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
,UNo
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?
❑ Ye!'�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 �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement? T-
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes P—No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect ]and application? If yes, check the appropriate box below. ❑Yeso ❑ NA ❑ NE
❑ Excessive Ponding 0 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 .❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes �' o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �j No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
[:]Yes ❑No ❑ NA ❑ NE
❑ Yes [JNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ff No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes E/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 Ef No
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
Sludge Survey
NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: Q
24,,Did•tht facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ✓CJ No ❑ NA ❑ NE
❑ Yes ,EJNo ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ 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
E�No
0 No
ETNo
o
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
Reviewer/Inspector Signature: Date: p X
Page 3 of 3 2/4/20I

Date of Visit: 2 Arrival Time: Departure Time: County: //yam Region:
Farm Name:T ) { 1�Qjfl•1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: " dig i! y Integrator: o
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
C►attle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) . P�oultr�
Layers
Design
Ca aci
CurrentDry
P,a
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars Pullets
Other
Other JELLOther
Turke s
Turkey Poults
Discharues and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c.' What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21417011 Continued

Facility Number: -C7 Date of Inspection: d
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 Stru e 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f ]
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
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[] 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
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ 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
❑ No
❑ NA
❑ NE
Required Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes [:]No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: j - Date of Inspection: / 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE.
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
[DNA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
Comments (refer, to question #):.Explain any YES answers and/or any additional recommendations or any -other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
� s�f`"Q-� C/r- 1 4 V"-1-,
3Q lz lc/7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: *211,12011
Date: Z

Type of Visit:.'O'Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O'koutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: * o eparture Time: County: Region:
Farm Name: fi rr. Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ��{' i LP Integrator: bn
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current.
I Desiga
C►urrent
Design
Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
C*attle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Di, P,oulh.
Ga aci
Pio
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
ti—Lother
Discharges and Stream Impacts
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 O-Vo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
jErNo
❑ NA
❑ NE
❑ Yes
�To
�jV"
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

FaciliNumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C215o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
O No
❑ NA
❑ NE
Struc�re 1 Structure Structure 3 Structure 4
Structure 5
Structure 6
Identifier:y/y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
E3*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
[Z�`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 2�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [-]Yes E3'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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 TNo
PTNo
❑ 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 _ZNo
❑ 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 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes G2'No
❑ NA
❑ NE
the appropriate box.
T
ElWUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:)Yes JZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
❑ NA [:3 NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA [] NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm/ [:]Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Z[ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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? ❑ Yes �No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary). _ d�
l � v
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes jZrNo ❑ NA ❑ NE
❑ Yes ;2"No ❑ NA ❑ NE
❑ Yes ,2fNo ❑ NA ❑ NE
❑ Yes �o ❑ NA.. ❑ NE
y/J_ lr/-,(/
/�4,17110
Reviewer/Inspector Name:
6,gZ
SM
Reviewer/Inspector Signature:
iel' oho!/,
❑ Yes eNo ❑ NA ❑ NE
Phone: MCI' �6 r-
Date: // 12Z111
Page 3 of 3

�'bl�%sion of Water Quality
�
,0 Drvlsian of Soil and�Water Conservation '�' � .�
,,
Type of Visit Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 1 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � i Arrival Time: .' Departure Time: County:
Farm Name: �%lC� _ _ _ _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:��S�u�
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Region:
� Phone No:
Integrator:
Operator Certification Number O �O/(�1
Back-up Certification Number:
Latitude: � c= 6�« Longitude: 0 0 0
t Design Current Des>gn Current" DesrginK Current
.-—:
Swlne� Capaclty{sP©pulation.. :Wet Poultry _Capacityf Populatton. CattleCa aci Po ulation
c ❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
El
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
IQC
Other
LJ Non -Lay.
,:'Dry Foul
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
oints
BEE
&Stream impacts
1. is any discharge observed from any part of the operation?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
� Nt
Discharges
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
m� � 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)?
v d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
� No
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
�] No
❑ NA
❑ NE
Page 1 of 3 I2/28/04 Continued
J

Facility Number: — Date of Inspection Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ff 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 0 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 11 Yes �'No ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ',0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ETNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ZNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,FNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Comments (refer to`question #): Explain any YES answers and/or any recornmendations,or any other &mments`'.,
Use drawings of facility to better explain situations. (u"se "additional pages -as necessary):
AL
Reviewer/Inspector Name F k.` Phone:
Reviewer/Inspector Signature: IDate: L L ( b
Page 2 of 3 12128104 Continued

�y
Facility Number: Date of Inspection 2 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4?�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes _;�rNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
gTNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J2 '' No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes O'No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes J] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ,l 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 -El 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 10 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 VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes [YNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
w ,✓ s�� ts��/.
Gv (c
7
/V/r v
Page 3 of 3 12128104

Type of Visit _Ck-Cbmpliance 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: Arrival Time: %�'J Departure Time: County: Region:
Farm Name:�Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title: Phone No:
Integrator:�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o [] c =, Longitude: = ° = =
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
ElNon-La ersEl
❑Beef Feeder
PE] Boars
Pullets
❑ Beef Brood Co
❑ Turkeys
Other.
❑ T rkey Pou Its
❑ Other
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes P<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 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?
`1
❑ Yes 4EJ�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes P o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection D
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 , fNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,-I'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ff No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
qNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
;2No
❑ 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
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
JoNo
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
VNo
❑ NA
❑ NE
1-3
y
Ise sca `e
�y rj S
7/_9 3 7
Page 3 of 3 12a8/04

Facility Number: Date of Inspection i CS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
ld t'f
en r rer.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes EZhlo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes JONo ❑ NA ❑ NE
❑ Yes ,�jNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,_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 F LNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J3No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ElNA [3NE
ElExcessive Ponding ElHydraulic Overload ❑ Frozen Ground ElHeavy Metals (Cu, Zn, etc.)�*o
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
.�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
o
el_`
ElNA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
LNo
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Camrrients4(refer toygneshon;#}�,yaE[gplarn any�YES answers and/or any recommendations Eir any other comments.
d awingsffoci�itywto-l�etter�,legplam�"situations:*(use'ad'ditional4pages as necessaryj:
Reviewer/Inspector Name �ibc.�/, Phone:
Reviewer/Inspector Signature: Date: ` %7
Page 2 of 3 12128104 Continued
II

;0 Division of Water Quality
Facility Number � ! O Division of Soil and Water Conservation
J- O Other Agency
Type of Visit Corr Hance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q outine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: Departure Time: County: &IT Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = = ' a Longitude: = o u
Swine
_Wean to Finish
_Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er I E_=]
I ❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
A,f
Design Current.. -'
Capacity Population;`-;
El Dairy Cow
[I Dairy Calf
El Dairy Heifei
[ID Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑B f
ee BroodCowl.
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
ElNE
❑ Yes
❑ o
ElYes
o
[I NA
El NE
El Yes
No
❑ NA
❑ NE
12178104 Continued

s Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes hd No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure'I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ry / [AC46A f 7—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LN q14
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Np ElNA ElNE
(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?
eat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaZo
7. Do any of the structures need maintenance or improvement? El Yes
❑ NA ❑ NE
S. 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)
4. 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
21 No ❑ NA Cl NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of 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
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
70<ElNA
[:1 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ENo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CK3❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IJ rNo ❑ 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):
2A) 3o O#ee 1 o MRIK ki f w/ aNAK f I��j . Ft�cJE cll&16-� lv ,BF44wl?.
)'!ILLS Cv #E &A/f AS #Ck6J.
Reviewer/Inspector Name Phone. v `j 34
Reviewer/Inspector Signature: Date: e 7
I &/4Of U-I LV/iii/.NGIF

I
r
Facility Number: 3 1 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t No ❑ NA ❑ NE
20. Does the facility fail to have all mponents of the CAWMP readily available? If yes, check E Yes ❑ No ❑ NA ❑ NE
the appropirate box. UP ❑ Checklists ❑ Design El Maps El Other ,�,�
21. Does record keeping need improvement? If yes, check the appropriate box below. Lr Y es ❑ No ❑ NA ❑ NE
❑ Waste Applicat� n ❑Wee ly Freeboard ❑Waste Analysis ❑Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain InspectionVNo
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 LJ No ❑ NA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N ElNA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYes No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes D No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes E�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 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 El Yes 0 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? El Yes �Ko
l/J ❑ NA El NE
33. Does facility require a follow-up visit by same agency? El Yes ❑ NA ❑ NE
Comments and/or Drawings:
12128104

I
ja Division of Water Quality
Facility Numtiec / O Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: �� %t{ ��rArrival Time: f D Departure Time: ' linty: �PG�i✓ Region: `*� r e
Farm Name•r. Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: G Q/ Title: Phone No:
Onsite Representative: FDDZf d•JQZC/G Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [= I Longitude: 0 o = , =
'Design Curren`f Design Current: Design Current:
SwineCapacity- Population Wet, Poultry. Capacity Population Cattle Capacity Population``
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other , -
❑ Other
❑ La er I ❑ Dairy Cow
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry -cow
❑ Non -Dairy
❑ Beef Stocker
LI Beef Feeder.
❑ Beef Brood Co
Number of Structures:
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
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes/No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

1
Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
StructK-ZL02
Structu
re Structure 3 Structure 4
Identifier: .4 �
Spillway?: pa
Designed Freeboard (in): ! r
Observed Freeboard (in): /g 5 Z
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 ;ZNo ❑ NA ElNE
ElYes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ;�No ❑ NA ❑ NE
❑ Yes ONo ❑ 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 oNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes )dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,.,('
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J,[I No ❑ NA [I NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. 2rYes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
``PAN ❑ PAN > 10% or 10 Ibs ElTotal Phosphorus ElFailure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ZZF., 6'g::j�'-
13. Soil type(s) Ah � , l r,o / " A
14. Do the receiving crops differ from those designated in the CAWMP?
X,Yes ❑ No
Cl NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Y/1es ❑ 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
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
'No
❑ Yes �No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments:
Use drawings of facility to better explain situations. (use additional pages as necessary):
F/Tq/L'f0 a(%
v
�l yo ?1�oS S ��� S�l�✓� LC�` r•� 0f�O�DS, /1%�� /0'"
l
j t u,DG /- ���. %a�z 7,Oe
Reviewer/]nspector Name p Phone:-
Reviewer/Inspector Signature: Date:
Page 2 of 3 - 12/2S/04 Continued

Facility Number: — Date of Inspection /
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? /Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No El NA El NE
the appropriate box.
El WUP ❑Checklists ❑Design ❑Maps El 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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes /No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZrNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? 9 Yes ❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? XYes ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes O No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? Rfyes ❑ No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30, At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes XNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes '0No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes gNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
Z3 �:,o 51
G dGr/�fc
l 4257E_0
W,4
Page 3 of 3 �-�� r2t2VO4

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ! Arrival Time: : Z eparture Time: , County:
Farm Name: 1&9ze!L &WtAl Owner Email:
Owner Name: )52Die A0P 66 Phone: _
Mailing Address:
Physical Address:
Facility Contact: . Title:
Onsite Representative: "7l�(2nf a! tl2w
Certified Operator: 4&2ti x
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Region:
Phone No:
/� _
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: ❑ ° = i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
_110 Non-Layet
Other
❑ Other I I-- -'
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
❑ Da Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: W'.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;�rNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

• Facility Nu mber:J97— Date of Inspection ?f D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 00No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes ❑ No ❑ NA ❑ NE
S#ructure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?: `v0
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;KNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 'Z 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 VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind7�e�m)
❑ Evidence of Wind Drifl Application Outside of Area12. Crop type(s) 6f� � 6ca.4 �•(rr �!/(� � Q
13. Soil type(s) d,�,4 4v A. & 'F I
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? ❑ Yes VNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes VNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes / No ❑ NA ❑ NE
{Comments;(referAo question #) Explain any YE Slanswers�and/or any recammendahon�s or any3athC .comments
�Usedrawmgs of facility to}better explain situations ;(useeaddttzonaltpages a�snecessary):
Rd
Gvy
�fXlszs 'F
-
Reviewer/Inspector NameT Phone:
Reviewer/Inspector Signature: 4 Date:
12128104 Continued

• Facility Number: 31 —41
Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑Checklists ❑ Design ❑Maps ❑Other
es 0No ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard )Waist Analysis ❑ Soil Analysis
El NA El NE
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
/Yes ElNo
❑ Yes 10 No
❑ Yes VNo
❑ Yes ljzfNo
❑ Yes ❑ No
❑ Yes )ZNo
❑ Yes XNo
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑ NA XNE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 9NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes ,go
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R�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 VNo
❑ 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 Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Add�tional.Comments and/or Drawingsi�r,��
2-4 14 �P,/ Q� ><2�ZG rLo.J zSRl7zan� �27s�
C�r�z,�5� /l/��f4
71f AW e4O V ln,6 Ar ?10 — 2
1 L�
TceFP ,Dnva-
61t�� AeC15��5
dO
/,S��tI�Q c.�®rll rf�17L �6� � .�✓ ��nl cG Q� /C�.�'Ga S
�ltJ G
W-W,
rzr2"4

Type of Visit Qf Compliance Inspection Q Operation Review () Lagoon Evaluation
Reason for Visit/ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
FFacilit_- Number I AJ Date of Visit: Doi Time-
1 10
Not O erational 0 Below Threshold
{ Permitted © Certified 0 Conditionally C ' ed. Registered Date Last Opera or Above Threshold:
Farm Name: County: V 14q)1'F d
Owner Name: _. �Q�C� Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: i tJ 51-1
Phone No:
Integrator: ._ ! I_ F
Certified Operator: Operator Certification Number:
Location of Farm:
*Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude o• o• o
:Design" Current Design Current
S
=Ca actives. reputation
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Nnmher of Lagooi►s ® ❑ Sul
HaIdtag'-Ponds l Solid Traps ❑ No
Longitude
z Design Cbrrenl
Cattle Cayactti ='=Population
�,a-vaaa;:afcaa�aa�.akraa.a�
Total'SSL
face Drains Present ❑ La oc
uid Waste Management 5vstem
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 comreyance 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
S,7cture l Structre 2 Structure 3 Structure 4 Structure 3
Identifier: {'
Freeboard (inches):
05103101
q
❑ Yes 1pqNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
XNo
❑ Yes
VNo
Structure 6
Continued

I
Facility Number: — JZT
Date of Inspection ! 8
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes lQ No
seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes /0 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) X
7- Do any of the structures need maintenance/improvement? Yes ❑No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes to No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidenceQf over application? , ❑ Excessivy�onding,, El PAN El Hydraulic Overload � Yes ZNo
0 W 0 X.M. OTV H11IPTISV«ate►;a.'.!+ ►1 Liil7.�,7.KW.O.,17MMO?:G M 30 M[MO W r
13. Do the receiving crops differ with those designated in the Certified 1ma1 Waste Management Plan (CAWMP)? ✓� ❑YesNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
'ZINo
b) Does the facility need a wettable acre determination?
❑ Yes
No
Yr-2No
c) This facility is pended for a wettable acre determination?
❑ Yes
Does the receiving crop need improvement?
Xyes15.
/❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Yes
[I No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
T
(ie/ WUP, checklists, design, maps, etc.)
ElYes
XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
A
21 Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�5No
24. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ZNo
I0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coanntents (refer to question #) Explaut any YES,suswers andior any reiommendattons :or any r tommentL
Lie drawings of fac htvv to -better txP ' in situations (use siddttrotxal pages as necessary) Field Conv ❑ Final Notec
- — _ i_ _ _ -
� az
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes </(� No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [ `lo
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 permanentitemporary cover? ❑ Yes Q No
Additional'Comments and/or Dra►tins; =e
%�o z C..- �C�,� �r �i✓S�ieE �.�ET�r
._� 7�
Ila;
I�L-r -5
IZ�
SDP
43 TNs G �,F�ac
ry�D AN 10VI-C G10 o -S L zA�/
G�r�f yF FG,o_5
--eo/n�rz/v�
iF�4 '4D,p
rely-rIez, Woo 14 'C' '0 fFSCyy:-- A�e"O'
Nam.= CIA065e, . Iternfeve o GAG -a✓
05103101 �,.l6� iL L Ff % G�� �FJQ/h `� 7-/% �G<PS#

=. Division 6f3Water Quality ,
• : ,Division of Soil And :Wate� ConserSation
�_Other'Agency {nv
;x
-
e
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit,,eRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number �O
1 Date of Visit: /O Oj I Time: I I sitElPrinted on: 7/21/2000
2:E210 Not Operational Q Below Threshold
❑ Permitted [3 Certified [] Conditionally Certified ❑ Registered Date Last Operated or above Threshold
C , Er' t �e r r �"1 County:..d/.U.01;'........................................... ........
FarmName: ....... ...........................................................................--------.......--.---------............................
rce............................................. _........................................
Owner Name: .............:......................................................................................................... Phone No:
Facility Contact:
Title:
Phone No:
MailingAddress:...........................................................................................................................................
Onsite Representative:.7�in ..... tl..:f J6l-.'..&A-t•-l...1-)S7`"........... integrator: _ ri �?l' f
Certified Operator:__ ............................................. ............................................................. Operator Certification Number:.......................:. ...........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �� ��� Longitude �• �� ���
Design, Current
Canaeity . Ponulation
-; Wean to Feeder
Feeder to Finish
Farrow to Wean
- Farrow to Feeder
Farrow to Finish
Gilts
Boars
3
Design Current Design ` Current
Potdtry Capacity Population Cattle .. Po tion
❑ Layer Fo
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity.:
Total SSLW .-
Subsurface Drains Present PLagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
DischaMM & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of die 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?
Strut ture I Structure 2 Structure 3
Identifier: .....................................................................
I Freeboard (inches): �� 3fO q f]
5100
❑ Spillway
Structure 4 Structure 5
❑ YesXNo
❑ YesXNo
❑ Yes No
h G
❑ Yes /R!:"qo
❑ Yes;eNo
❑ Yes '11N0
❑ Yes
Structure 6
Continued on back

Facility Nµmber: 3 — 1 [ Date of Inspection IQ D 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ,&No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes Mo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes '0"No
Waste Application
10. Are there any buffers that need maintenancetimprovement? ❑ Yes
�No
11. Is there evidence of over application? ❑ Excessive Ponding�PAN ❑ Hydraulic Overload es ❑ Np
r
12. Crop type FesC ve �, zC� }/ r►ti v�(R er rti Q ('j 1�tZP So b as rl r a h �l� e Farms; -�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes-;3glo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes [].No
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?
'Ja4es ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Ye'Po
Required Records & Documents r
17. Fail to have Certificate of Coverage & General Permit readily available? *5es AffNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Ye!1�0
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ErNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes i 'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �o
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes xfNo
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ,eyes ❑ No
yiipl ttiQnjs :off dt f c1epct v re pQtet� d ciii9 this'vis1t; X 0 vtwili ree�iye Rio futth�r • //////
6 i es fence aNkti this visit.
_ - _ ,
Comments (refer toquestion #) Explain any YES answers and/or any recommendations or any other comments._
Use tirawings.af facility to better ` fain situations (u§e additional pages as°nec "T '
Pam'}
t. Qve 0cd pggj or 2aoo-- 2aol. s�t fl
1 l. A/eed5 a c_,,e (xt/e attire Olekrr�,r�q �ia-, t,�/�' , ✓" ►%+c-h(') WC4.5- e- FAVA il rec-orris
kelq
IS. geed 4a-�'es�ve rm areas off' F;e1�ls al eS;S-�e�{ as �esc.re w�t.C�.
Gu1'fe&q1y ►'
have o_Fescue .
Ned I� have +ke COC -ra{ 8� & F1"
Reviewer/Inspector Name fl",_',"h
Reviewer/Inspector Signature: Date: 30 Q I 5/00

Facility Number: — / /41 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 i No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yesle No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes zNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes /ETNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �,ffNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments an or ravings• -
�,O Use WV Sa e CIiA41yC:.r da�r-d L".o.4 A, &0 d. off' a�� �;c�,�or,
a�0
•
ve''1(s or, 41,e �r� Z1-s Kc-P.1��2r5 arl � �SCO-SOh LCcSOS.
2'5-• /Veed -to cidkCKe -fO t�Cct i Lv+'\dat,./ -6f fesCve 9;%tert Jrl
I t�l
Wa4e fl h
AAc4 4-o b4r- o/ja 1ize ircebo,,-,d r'ecard s - Ai4rd 4o,
USe S-D 165. FINIA(re qs 4ke �Q 1rtnly al OLW Oln ce ro—
Srvr� rqlker -�,qrl 7S s .sent,✓h ,
2 J�L£�6Yi-�, .. �1/}� 5 -f A ✓ 'n'� r S bCj 6 +'�!j L'P F rq 4e 4 V el Gi'e✓ 44 Sa A-xc W a
!A rkvt Ike .SC"� -,e G co ry✓''1 or,
Y`r i pi i on e 'r 4�C A G k in ve
:W r` s are keep Setwr-t�e Ae-rti 41ne
S r-O'k4 04 )1e se
l.,-�a� �e rv�a ►1�. 9e,�-tee v�'i �•�.s }C�w, I 4 p be --ye, • r-w,
f'�f'"'► needs 4-o o �-, aria rler► �v� � 1' op¢/ a )ors 3 As'
5100

`
` j'�" y
`
rvision of Soil an Water Conservataon
Other:Agency r
r� -
�Q
�� Y�
f-
4.: �� �-.:C f. -; .'Y �'u+ n �. ' .. ,t .-.
».. - •:'t - - _, _ . ... - _ .. .....1' _ - - _,.�� _ -
i..r ,. ........ .. ?:K-i. .. � �w� _-- So- . .%i��x
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Poutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 07 %�-�� /t 0V Time: Printed on: 7/21/2000
t2E r ,
Q Not Operational Q Below Threshold
Permitted kLCertified El Conditionally Certified 0 Registered Date Last Operate>LQ,,r Above Threshold:
FarmName: .............._...... .....:J :..:.........� z'..........'e'"............................................ County:....._I.... __.I!.r.................... `
Owner Name ................................. Phone ND:............ ...��......1/ d?... Cf .?.... .
Facility Contact: ... 5 .......... Title: ............. .. Phone No: ...................................................
Mailing Address:
Onsite Representative: i _„ . ........... ........... Integrator:.-„---
Certified Operator: ..... ............................_ ....... Operator Certii5cation Nun er......................................
Location of Farm:
T
Swine []Poultry []Cattle ❑ Norse Latitude �� �° Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE3 Layer I 1 ❑ Dairy
Feeder to Finish '731/ ❑ Non -Layer I 1 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes f(No
Discharge originated at: El 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) El Yes ❑ No
c. IF dischan c is observed. what is the estimalcd flow in gal/ntin`' Lypf,
d. Does discharge bypass a lagoon system:' (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pats of the operation? ❑ Yes PqNo
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?
Structr I Struc;tur It Structure 3
?I -
Identifier: .............. . ...........---............--..----.
Freeboard (inches): ! Z
v
5100
❑ Spillway ❑ Yes Q No
Structure 4 Structure 5 Structure 6
Continued on back

Facility Number: — ZZ,2 I Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obs rued. (ie/ trees, severe erosion, ❑ Yes 4NO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? - ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes j�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
I0. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ xcessive Ponding ❑ PAN ❑ Hydraulic Overload El Yes JNo
12. Crop type 1)5�21,94 . 46A,
13. Do the receiving crops did er with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Wlo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Z'No
b) Does the facility need a wettable acre determination? ❑ Yes jfislo
c) This facility is pended for a wettable acre determination? ❑ Yes tvo
15. Does the receiving crop need improvement? .@�fes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes &No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes X&O
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(le/ W[3P, checklists, design, maps, etc.)
Yes El+Io
lui
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) Yes ❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes I�No
21, Did the facility fail to have a actively certified operator in charge? ❑ Yes ,ENo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application) ❑ Yes (%No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [ �10
24. Does facility require a follow-up visit by same agency? ❑ Yes [RNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? WYes ❑ No
E; , No •yiolaiions ©r detjcieucie5 ,**ere p6ted- diWifig tbis:visit: - Yoi� will •receive tiW lrurther ..
....Co. i respondence- about: this visit-' • ' :::::::::::::::: .
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any.other comments.
Use gs of facility to better explain situations. (use additional pages as necessary):
TIV W"16, �� X&411
:_.2)
�Olav_ )Aa&, /Irt f, /W ell"
3 �_ �� y 3 _ 4Z 7)
)0 j (,A t —Y)elr 44 f- 64 0( rer4, 0/-- e�-re�otj t-
Reviewer/Inspector Name
Reviewer/InspectorSignature:*
Date:

IFacility Number: j 1— [t"� Date of l.uspection l:'rinted on: 7/21/2000
Odor Issues T�
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below es ❑ No
liquid level of lagoon or storage pond with no agitation? \
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [§No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes C,9,No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes EgANo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes E3,Mo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Ply -es ❑ No
Additional omments and/orDrawings:
'w/
WUP
CLPWR/V dv,
5100

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
12 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other J
Date of Inspection s Sg
Facility Number,
Time of Inspection Gb 24 hr. (hh:mm)
Registered IR Certified © Applied for Permit © Permitted JE3 Not Operational I Date Last Operated:
Farm Name:.----- ...a....... `....... fi
.rt. ............................................... County: ........ Dl�kn.................................... ... I...................
Owner Name:................................................4�r..................... Phone �'o:...�.14i..9." .
//'� ....................................................
Facility Contact: L c'`` . ..vsl . ........................ Tittle.' ---....................................... Phone No:..........--...---...----..........................
Mailing Address: ............43.1.Z........s� s� s.......SFa!t .-..........1 1.:..... � :.... fkil .... ..fJC ... .......
/y t --
Onsite Representative:........... ar-..I........ v5t'11_�.................................................... Integrator:......... ...............
Certified Operator:............................................................................................................... Operator Certification Number;.........................................
Location of Farm:
x......�c s r........... s►. %n... S?.........: .,... � �. .1.....�. L.. tx. i �.5... tiS.......R.........t&110..................................................................I. i
.......................................... ....................................................... .._ ...................._.................................................. .
Latitude =0 6 46 Longitude =0 6 64
Design Current
Design . Current ,_
-Design Current
Stivme4 .'• Capacity ::Population :': _ Paultt y .:'
Capacity Populatiaez Cattle'Capacity
Papulatron $'
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
13q
❑ Non -Layer I
JE] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Others•
;
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
Boars
-
TofiifssLW'
Number of Lagoonsl
t
Holding Ponds'
.
❑ Subsurface Drains Present JJEI
Lagoon Area
ID Spray Field Area
M
wr w ❑ No Liquid Waste Management System
w
General
i. Are there any buffers that need maintenance/improvement? ❑ Yes Wo
2. Is any discharge observed from any part of the operation? ❑ Yes q No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes to No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes $1 No
c. If discharge is observed, what is the estimated flow in -at/min? �1
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes WNo
5. Does any part of the waste management system (other than tagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6_ Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [� No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

Facility Number: j ` —
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
�NNo
Structures (Lagoon5Aolding Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
Oallo
Structure t Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:IZ
............................................................................................................................ ..................................
Freeboard (fl): ............ :. .........................34...................................
...............
10.
Is seepage observed from any of the structures?
❑ Yes
RNo
U.
Is erosion, or any other threats to the integrity of any of the structures observed?
Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
EJ No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
10 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .................. k�1.I��?-............ ..............SML��..... 4 h ........................................................................................................,
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
® Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
lP No
20.
Does facility require a follow-up visit by same agency?
.9 Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Onl<<
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
(R No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
0Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
[9Yes
❑ No
[3, No.violationsor' de'ficiencie's:were-noted-during this,visit.- You,will rece'ie�n voItirther-
: _ eorrespi)Oeince abbid Ibis:visit::: .: ::.::::::
!~om�ents (refer fo. gtxest�ion #� E�tpiarn any YES answers and/or, any recommendations or any other comments �. � � ,
Us t�Ca►w ngs'oif�diity tobettes expiautres,tuab�.s. (u atldttonaljpages as F`necessaFj,� �_-`�"� �� ��j �< ` 4
C
�V f�`,: y Sri
11-jIZ V q � �",_,L ko� laZ. thovco '04 o (��ooti
W0 isr,L $"�oJ�� t4_ tw ve ri ��►. � tc� WhAt of C�or Z. ° �1 ma`s
6tAf-r Jz-V_ . La)O of lao (a)GOAA co'J' � bOI QA� s4►e�l� �� � G�Y�' s:t1�- �c�r-ce�� �,.
r CA-GeJVkA. U .c_N -{{6,jW Le- "We-J ,
vl
1$• �rCd:2. 4— �¢y7l.udb. �Y6�] 5koU aer %,,,, jyVVCJ,
�,J11 NA-b k1 ew,tc-f"
Li C, 4 4c,_ n4w-p— 6,J6,�t, �,��a�. ,rr; c on ae-v; 55
Rv►.- rccor�C . at.r' z c��a►� +W t ► - St�ov�� Or•. 5
>�4 ram• wC.t�-�'iU �lvcc� '�-`� `{�-+'� 15 li s }t� {ram {,.1 v� 7/25197 H
Reviewer/Inspector Name 3� �v
Reviewer/Inspector Signature: Date: $ S

;- ❑DSWC An><ma1 Feedlot Operation Renew
_ * -f., '_r 5'. r f a�� '. s-7yy;s"�y„ �,m'�,�y f$r, �•�>. �� �!zw�kC" :_
ffDWQ Animal e'edlot,�Operanon Safe Inspect>on
'*'Routine • Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other j
Facility Number
Farm Status—' �` 4
Date of Inspection 1 S- 4 -IT
Time of Inspection EZ= Use 24 hr. time
Total Time (in hours) Spent onReview
or Inspection (includes travel and processing)
Farm Name: G e cpt `— l i County:
Owner Name: , _ �>s ._ _. _ . Phone No:._
Mailing Address:
Onsite Representative: PA-cl ! AJ _� Integrator:
Certified Operator AN&)�2.,2 W ` "Operator Certification lumber:
Location of Farm: -7 41. -1(Z OSLy
0
Latitude 0Longitude �• �� °�
❑ Not Operational Date Last Operated:
I}fie of Operation and Design Capacity
`
x
r <
SrYinex m �� ,Number M
Pogltry # x Number RWCattie ;.Number
El Wean to Feeder
❑ Laver
❑ DaLry
Feeder to Finish i 3C
171
end
: ,Number of I;a;oons'f Holding Ponds �' ❑ Subsurface Drains Present
�s�a "°�`�`�� .z• i rs...+'�_'°:e�.s-na". FX �"�":.u�x� ^ x-,��hr -z Yr '.es+`" �s�-v� �+.h� s:.i
,�', '�."" �" '� - r' .s;"' o.,z sx * r �,,,. c a..,�a "..,. �. ❑ Lagoon :area ":k: ❑ Sprav Field Area m . a
.�"�. ;�' :�. . ;x;:;t. ,..a....,„ -«fi � ..�r� .�f•; .'�`„�`.-:�s.�a.:�i.. do - wYc A,=a": ;�.
General
1. Are there any butlers that need maintenancelimprovement?
2_ Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discbargge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
. - ; . Is there evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
- ❑ Yes ®No
5. Does any part of the waste management system {other than lagoons/holding ponds} require
rr:aintena.•tce.'improvement'?
❑ Yes
[ONO
❑ Yes
®No
❑ Yes
®No
❑ Yes
0 No
❑ Yes
OR No
❑ Yes'
'g] Na
,Yes
❑ No

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)?
8. Are there Iagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon 1 La,aoon 2 Lagoon 3
z-s 2.7
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the strucrures observed?
12. Do any of the structures need maintenance/improvement?
(I€ 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 adquate markers to identify start and stop pumping levels?
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. C rop type - •
4 / 9 _ Z
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?-
18. Does the cover crop need improvement?
I9. Is there a lack of available irrigation equipment?
For Certified Facilities On1y-
20. Does the facility fail to have a copy of the Animal Waste Management Plan re`diiy available?
21. Does the facility fail to comply with the Animal Waste Management Plan in =v way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewerllnspector fail to discuss review/inspectiou with owner or ope atcr in charge?
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Reviewer/Inspector Name-
Reviwer/fnspector Signature: Date:-"�
cc. Division of Warer Quality, Water Quality Section, Facility Assessment Unit 11/1-1/96

t} �
N.C. Department of Environment, Health, and Natural Resources
Telephone Log
Date: 3/27/97 Sheet 1 of 1
Time: 1:45 to 1:50 ❑ am Call: Placed ❑ Received x
x pm Returned ❑
PROJECT: Eddie Brice Hog Farm
COUNTY: Duplin
CONVERSATION WITH: Complainant wishes to retrain anonymous.
TELEPHONE: (N/A)
AFFILIATION: Performed some bulldozer work on the site as part of the lagoon installations.
CONTENT OF CONVERSATION: The complainant stated that during the lagoon installations they
were instructed to work in an area that they feel are almost certainly in wetlands. The complainant was instructed to install at least one of
the lagoons in the wetlands and one corner of the lagoon is less than 50' from an "active" creek. The complainant asked the farm owner,
Mr. Brice, if they weren't too close to these features and questioned how he could be permitted to do this activity by the "EPA". The
complainant claimed that in less nice words, Mr. Brice stated he didn't care what the EPA thought. The complainant said that Mr. Brice
lives in South Carolina and that the farm is run by a local manager and is part of Murphy Farms. The complainant stated that to get to the
farm, you take Hwy 903 from Magnolia and arrive at Waycross road approximately five miles from Magnolia. You take a right on
Waycross Road and approximately three miles down this road on the left is the farm. There are three lagoons at this site and the lagoon
closest to the creek is at farm #3. The complainant stated that he believes there are at least 20 hog lagoons in a two mile radius in that
area. I told him I would pass his complaint on to the appropriate authorities in our Division for considerationlinvestigation. He did not
want to leave a voice mail message on anyone's voice mail. He apparently wanted to pass the information on directly to the rust person
he could reach by phone in our Division.
cc: wIKu - wVl. Dave nolsinger knea isy: ltfruce K. rams, wIKtJ-tiw5
S:IGWSIPARRISINONUSTIBRICEFAR.TLG 3/27/97

Site Requires Immediate Attention: A -0
Facility No. -3 t 115
DIVISION OF ENVIRONMENTAL MANAGEMENT 3 1
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
. DATE: 'V tt4 1995
Time:
Farm Name/Owner: - 3 Uflf--
Address: 0113 a `r) $
County:
Integrator. Phone:
On Site Representative: Phone:(P1 d) a'b
Physical Address/Location:
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: _ �e- a g&'a ['C Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 dour stormevent
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: iQt Ft_ Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? - Yes or 00
• Is adequate land available for spray? e or No Is the cover crop adequate? es or No
Crop(s) being utilized: c O
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Q or No
100 Feet from Wells? Yes or No
Is the animal waste'stockpiled within 100 Feet of USGS Blue Line Stream? Ces br No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-made devices? Yes oOy If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: (1" L5 4 -I 1 ka. 1 --A;�L�
s
Inspector Name
Signaturdl
cc: Facility Assessment Unit
41
Use Attachments if Needed.