310784_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: (P Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (6 Routine 0 Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: j J Departure Time: ❑ County: Region:
Farm Name: j e rcL Nu ry ri Owner Email:
Owner Name: �" 144 Eh in" Phone:
Mailing Address:
Physical Address: Facility Contact: On o4-1 cS 60Gr"� Title: Phone: f 0 Urg IL4 Z 6F
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design C*urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
1DRIen Current
I)r, P,ouIt C•.a aci P.o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
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 4J/No ❑ NA ❑ NE
❑ Yes ❑ No f) NA ❑ NE
❑ Yes ❑ No f2 NA ❑ NE
❑ Yes ❑ No NA ❑ NE
[] Yes [ No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
21412015 Continued
r;

Facility Number; 3 1 - Date of Inspection:
Waste Collection& Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 17 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes IT No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes T No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes &(No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [4 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 q 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 gNo ❑ 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 " [7No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZjNo
❑ NA
❑ NE
l8. Is there a lack of properly operating waste application equipment?
❑ Yes
C5-No
[] NA
❑ NE
Required Records & Documents
l9. 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.
T
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
. Does record keeping need improvement? If yes, check the appropriate box below.
9 YesIrnsfers
No
❑ NA ❑ NE
NWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste
❑ 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
Ct No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA P�NE
Page 2 of 3
21412015 Continued

f'acili Number: - ILL Date of Inspection: I 5Ej'Z_kj
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. TT
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of First survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No -0 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
[jfl No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[$ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
A 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
(7 No
❑ NA
0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Continents (refer to question #) Explain any YES'answers and/or any additional:recommendations or;aay other comments"
Use drawings of facility to better.explainsiivatiops (qse additional pages as necessary):
Wt, Sjlldn <0M
4a')C.Cv�f �V 2b jC1
CIA �, Vil v - 3 ) -4 \-I vp��tC Gvyan� `^'�S4q�(�'c`�'�fr"
-tnlc.Sc�. a�.�`1 �13 — ncaQ v'l
Reviewer/Inspector Name: ;k . \rJy ` '
Reviewer/Inspector Signature:
Page 3 of 3
jo��
Phone: 7P
Date: l'L Zy
21412015

Type of Visit: JD].E-ompliance 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 0 Denied Access
Date of Visit: 1,7
! / Arrival Time: Q Departure Time: County: jn,Region: k.� LICE
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification tuber:
Certification Number:
Longitude:
Design Current
Capacity Pop.
Finish
rWgn
Wet Poultry
La er
Design Current
Capaci11 ty Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
Farrow to Wean
Design Current
Dai Heifer
D Cow
Farrow to Feeder
Farrow to Finish
Dr, P,o_ult Ca aci P,o ..
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
113cef
Boars
Pullets
Brood Cow
Qther
Other
Turke s
Turke 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?
Page I of 3
❑ Ye�No ❑ NA ❑ NE
❑ Yes [:j'No ❑ NA ❑ NE
[]Yes jam-' "'o ❑ NA ❑ NE
❑ Yes L2rgo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21412015 Continued

Facili Number: - Date of Inspection; ZZ
Waste collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes L'fvo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes El"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 ,E�jNo
❑ 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 ZrNo
❑ 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 E;:'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑01 fo
❑ 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 J201 fo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes J2'1'o
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 2<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,2]14o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�ro ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes U;rlZ ❑ 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?
Reauired Records & Documents
❑ Yes J2<o
❑ Yes 00,90
❑ NA ❑ NE
❑NA ❑NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes', i o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes IQ<o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Id No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [;2�o
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 4�No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

J
[Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes :; No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] YesTJ;]O1Qb ❑ 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 �► o DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes Rio ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes',L�r%o ❑ 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 fo ❑ 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 [J�o D 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_,E;Io ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 9,W ❑ 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 afollow-up visit by the same agency? ❑Yes o ❑ NA [] NE
Comiitentsk(refeltoquestion#}' EzplainanyYE5answcrs andlor any additional recommendations o"r any other comiments.: . .
m
[Iseiirawings of faell tyito better explain situations;(use addrtional,pagesas necessary), t ; _ .
ua,ts 016 c� -� �-d iCo cti►r� �/�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:& "0z -I
Z
Date: 2
2111201

Type of Visit; 'Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: ,t/ Cco ( k-- Region:
Farm Name:Pfe rce� T l• �Owner Email:
_�
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C %
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number;
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Deslgn Current
Wet Poultry Capacity Pap.
I ILayer
EE
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Feeder to Finish
I jNon-LMer I
Dairy Calf
Dairy Heifer
Farrow to Wean
Design C►urgent
D . P,oult . Ca aci Po P.
ILavers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layer
beef Feeder
lBedn—od
Boars
Pullets
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 �'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes rno
❑ Yes o
❑ Yes �F)No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste;Collectlon & 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 FNo ❑ 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 ONo
❑ 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 o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
:/E5,No
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement? /T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement? —/
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ' 2 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 ;_2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes o
❑ 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 J�T No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes )�J`No
❑ 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
❑ NA
❑ NE
the appropriate box.
eGTI�o
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 VNo
o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: rpate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes, ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ 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 PNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes /�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �o ❑ 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 prfio ❑ 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 ONo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ;dNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PrNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
[XNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes PrNo ❑ NA ❑ NE
Commerits(refe%to�question#)Explalnai;yYES§'an'swers'ainil/nr'anyudiiitional reeoirimendation'sor��any other c"omments.
Use drawmgs'af facilityto befte ez `la n situations'( se�ailditinngi� gqk as nec sa } a �,,
5-1 t6[ (5'_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
yf,
Phone: -7—,32
Date:
i��_,57­/
'�
2/4aM
t

k
Type ofvisit: 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 0 Denied Access
"Date of Visit: Arrival Time: cam- eparture Time: County: /� Region:
Farm NameOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: l Title:
Onsite Representative: C%C
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator: 22=
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultray
Capacity
Pop.
Cattle Capacity Pop.
Finish
La er
Dai Cow
Feeder
Non -Layer
Pairy Calf
o Finish
airy Heifer
o Wean
E,Farrow
Design
Current
D Cow
o Feeder
I) , P,oult .
Ca aci
P■o
Non -Dairy
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
10ther
NJ Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑ No ❑ NA ❑ NE
❑ 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 I of 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D—No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes J'Rio
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ePj No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes TD-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 ,ETNo
❑ 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 12-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �allo
❑ NA
D NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E]-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 5;�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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? C] Yes [INo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: CP
Date of Inspection: �Z /
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 Fl 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 Jallo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes _E3'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:
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes �'No ❑ NA ❑ NE
❑ Yes effNo ❑ NA ❑ NE
❑ Yes ,E�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes _[:I No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes d 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).
Iffed 1 &�e S �-tr L) 0-/ -�3 (_ 9Q 1-3
records Ll-\ 3,0V6 C C&Of
111711
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Date of Visit: Arrival Time: : Departure Time: LJ County , Region:CV
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: /92114Z
if
Certification Number:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
C*attle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
11
1 jNon-LUer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. PTu-ltr,
Ca aci
Pao .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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)
e. 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 23'No ❑ NA ❑ NE
❑ Yes EE'No
[—]Yes ❑'Ivo
❑ Yes E�"No
❑ Yes ,rio
❑ Yes �ff No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of ins ection: �3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes EfNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J;3-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 ,frlo ❑ 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 J2�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
Poll
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [J No
�] NA
❑ NE
maintenance or improvement?
r
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2<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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment? +
_Rewired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes f5No
❑ Yes ,ffNo
❑ Yes );a'No
❑ Yes [;�No
❑ Yes TP0110
❑ Yes ONo
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EpNo
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,ErNo
❑ 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 ❑ Np
Page 2 of 3
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
21412011 Continued

Facility Number: jDate of Inspection:
IV
24. Did'the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes [ No ❑ NA ❑ NE
25. Is `the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo ❑ 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 PrNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes )21�o ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 'C;�"No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [�*o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. 'e
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes .0 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
�To
❑ Yes Ea
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes TKNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ,ffNo
❑ 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).
�,,,�. ® - o � l 7
. r
m !
1
l 17 �3
C)c6
l0.7 Ll
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: a
Date: 2
21412 11

r Facility Nu
Type of Visit
Reason for Visit
Date of Visit: ld
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
iliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Arrival Time: Departure Time: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
w
6
Region:
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = f =Ig Longitude: = o = , ❑ "
'Oil�jfi � tLrDsi�gngn
Cn�rrenf:
Design Current
Design Current
Swine apacity'pulatiort
Wet Poultry
Capacity Pop�u�la n'
Cattle. Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai
Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai
Calf
❑ Feeder to Finish
l
❑
Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑
D Cow
❑ Farrow to Feeder
❑
Non -Dairy
❑ Farrow to Finish
❑ Layers
❑
Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef
Feeder
❑ Boars
❑ Pullets
= ❑Beef
Brood Cow
❑ Turke s
Other :
El Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No El NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No El NA El NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [Kod ❑ NA ElNE
[3Yes [o El NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection p
'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:
El Yes XNo ❑ NA ❑ NE
❑ Yes _2-No []NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �To ❑ NA [:IN E
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /�2<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application dNo
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes i❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R 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 1Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
El NA
El NE
'Ie17.
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 2 No
❑ NA
❑ NE
ss,„' .��..6,.
Comments (refer tnEquestion #) Ezplam,any YES answers'and/or}anytrecommendations or any o hcr��comments g
Use drawings of facility to better explain situations: {use additional page`s as necessary):_ . X yY ' F; t
®r
Reviewer/inspector Name : '� �° ; r ti t)e 4� #
Phone:
,s ��
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection CJ ;L-7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? es 0 No ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check ❑ Yes ezNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,ETNo ❑ 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
4'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
A'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�3`No
❑ NA
❑ NE
26.
Did the -facility fail to have an actively certified operator in charge?
[:]Yes
�TNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;2rNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P'&o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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
J!fNo
❑ 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
VNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments: aud/or,,Prawings:
mii':& IM
�O
�. 3
5 &4 C1,J
��/3165grUv
Ak
�,* lewe.,l 'j Q
s� ,. I t ew'-A- y ou uy
1- 3
plaou o
Cer c , IC, C_a.
pt'�-- " 64-".
T
Page 3 of 3 12128104

,.F ,�ision of Water Quality
cility Number O Division of Soil and Water:Conservation
O Other Agency
Type of Visit �npliance 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: T. Departure Time: County: vee inl7 . Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
01/
Onsite Representative: "eo.r.4
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
�o
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
0" Longitude: = ° =' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
ElTurke 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
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
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 ;2rNo ❑ NA FINE
❑Yes
❑No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �N El NA El NE
❑ Yes ❑ NA ❑ NE
12128104 Continued

.F'aciiit3lill. Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (?fo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
01�o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ZNo
❑ 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
5KNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
;;No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
�^No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
UTIo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
C20l
❑ 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 ',0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
2fo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LR Noo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L?l
❑ NA
❑ NE
Comments (refer to question # : Explain any YE5 answers and/or any recommendations or any other comments.
Use drawings of facility. to better explain situations. (use additional pages as necessary):
a
Iwo
Reviewer/Inspector Name-���,' R r,zs�t�;,; Ph one;
Reviewer/Inspector Signature: Date: 'Z
Page 2 of 3 12128104 ' Continued

Ftkeilirty Number: — Date of Inspection 11T?T& fJ
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 t` No he CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. .eyes�o El NA ❑ NE
El Waste Application [I Weekly Freeboard 2 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 4TNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ANo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P�'No
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
3 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[;?No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Jallo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eNo
❑ 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?
ElYes
2<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[INo
❑ 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
[2rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E�No
❑ NA
❑ NE
AddditionalCommentan`dlorDra�ivi gs: <��
11016.7
Jk
�/�' ��
0• �
���g l sir' ,�..
a s
7
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access 1 Q
Date of Visit: Nrrival Time: / eparture Time: Q County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L� R
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ i ❑dt Longitude: = o =' = "
Design Current
Design
Current Design C*urrent
Swine Capacity Population 00 Poultry
Capacity
PopulaC tion Cattle apacity Population
I ❑ Dairy Cow
1 ❑ Dairy Calf
❑ Dairy Heifer
❑ Wean to Finish
JEI Layer I
MINVean to Feeder
19
1
ILI Non -Layer I
Feeder to Finish
❑ Farrow to Wean
Dry Poultry
apry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turke s
Othe 10 Turkey Pouits
Nurnber of Structures: 4
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ YesPllNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes A No
❑ NA
❑ NE
❑ YesXNo
❑ NA
❑ NE
12128104
Continued

iF'acility.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?
tructure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(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
❑ Yes ❑ No
Structure 5
El NA El NE
El NA El NE
Structure 6
❑ Yes
14No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ N13
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 El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes 41 ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�/
9. Does any part of the waste management system other than the waste structures require El Yes fJ No [I NA ❑ NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IyNo ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Dr'ft ❑ Application tside of Area
12. Crop type(s)Al-veA4116AV �� Dl� ro�LfiO
13.
rr
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
/1-1
No []NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
XNo ❑ 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):
7o— 64)X TA le Ce /¢1f2 4
A.
Reviewer/Inspector Name Phone: /� 3 Z
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection �4 d
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ElWUP ElChecklists [IDesign El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No El NA El NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis El Soil Analysis El 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?
❑ YesNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rambreakers on irrigation equipment?
❑ Yes
❑ No
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No
tVNA
[I NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
)ZNA
❑ 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
;dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ao
[I NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
:ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
onjtJ
�.
Page 3 of 3 12128104

Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit,..�Moutine O Complaint O Follow up O Referral 0 Emergency () Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: —S . Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c [= Longitude: = ° [= 4
Design Current Design Current Design
C►urr.ent
e Capacity Population Wet Poultry Capacity Population Cattle Capacity
Population
ean to Finish S ❑ Layer El Dairy Cow
ITEOIFeeder
ean to Feeder
❑ Non -Layer
❑ DairyCalf
to Finish
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
Beef Stocker
❑ Beef Feeder
Brood Cow
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder ❑ Layers
El Farrow to FinishEl
El Gilts ❑ Non -Layers
❑ Boars ❑Pullets
❑❑Beef
Turkeys
Other ❑Turkey Puults
❑ Other ❑ Other I
I Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of d
❑ Yes ,2No ❑ NA [:1 NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
-E] No
❑ NA
❑ NE
12128104 Continued

Facility Number: — ' $ I Date of Inspection
Warte Collection & Treatm nt
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Rio ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stnucture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: '
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2r�0
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [ ^o
[I NA El 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 oNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [kl$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'?
f�
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes P14o
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes Q 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 ❑ Application Outside of Area
ooff,,Wind
%Drift
,
12. Crop type(s) RlerMhO., -566P1xr2 Al ,�Z
�j�`
V
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
r
[Yes No
ti
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
16) 11uvrenf) W 1415
4 rR W4 R� (a A6yes
r
Reviewerllnspector Name I Kevty\.,Af Phone:
Reviewerllnspector Signature: j Date: c
Page 2 of 3 1212 /D4 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E2rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
'1NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
L'NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
V] No
❑ NA
❑0� NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
2 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
[ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
ffNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Y11 Q� I y-aivv�(� 1 Lckez Lns9ec44eoh
I�c,Ur� crop y���c�s o, .
Mr. �\)cock_ 400� ooarr on ariLca f�,00G, Oe Kas ckart�,ed, 4-o
�.�.
i
_10 4,4--
CkO,rVS 4Cock hneu, -.6k_ fiver 4,�
qo t e o Y-do '
o�
tom~
Page 3 of 3 12128104

IType of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit,Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 4 G Time:
O Not Operational O Below Threshold
alpermitted,MIj ertified © Conditionally Certified 13 Registered Date -Last Operated or
s� Ab�ve Threshold: _...WW . ... _..
FarmName: .{ � .._ .. .__..._ . _.» » County:... �1a, .1 9................. ...... ....... _._.... ...... _.
OwnerName: ..... ».... »..»......... ............... ..._.... ._............. _......._._......._.............._....... 'Phone No: ............... ..._... — .._ ..._...._......._.
MailingAddress:.._ . »._..._.__..._.._ _...... _ . ... » .... . » ...... _... W . _ . ».» _ .».. ..... _..____ ...... » .»..........._.....
FacilityContact: ... ._.... ... ..._.... ......_.............. ».. »...... Title:.._._.......».........................»»...».».......... Phone No: _. » .......»..». . ».. __....
Onsite Representative:. 5� C.�.� G e _ .. __. _..._.. Integrator: _„�„✓.. ._. _ .. ____..._..
CertifiedOperator:.__. ......_........................ ». »»...»..»...».. ............_....._ .... Operator Certification Nunnber:._....._ _.....».......,.»..»....
Location of Farm:
wine P40ultry ❑ Cattle ❑ Horse Latitude • 04 0« Longitude • 0` 44
Disclraraes & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes ZNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ARMo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes _E3vo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l _ »» .......... ..._._ .... _ .._....._.........»_........................_..._._--....._.»................... .....
_..._._
Freeboard (inches):
1.2112103 Continued

Facility Number: — Date of Inspection
5. , Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes _PNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [2-No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes E]No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes 'Ovo
9. Do any stuctures tacit adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 1019�0
elevation markings?
Waste AiRplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'ONO
11. Is there evidence of over application? If yes, check the appropriate box below. �MTes _JM�o
❑ Excessive Po�nding ❑ PAN
, 3 Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc l
12. Crop type _1. T 1'�X�{[X�.( � LL1�.�r�Ly� ►� .S c �� OVer�I."P c4J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,®'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes E3No
b) Does the facility need a wettable acre determination? ❑ Yes •fNo
c) This facility is pended for a wettable acre determination? ❑ Yes _E'Ro
15. Does the receiving crop need improvement? ❑ Yes ZNo
16. Is there a lack of adequate waste application equipment? ❑ Yes J-No
Odor Lssues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes c TRio
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,ARNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes , 2-wo
Air Quality representative immediately.
�'i7 'pf'3kt?_ ,•..•13'lt..�';,Y�i�lR�7 ..�...,�•••faNE�11�L'RfinL'�.#%FRtl.,2�:9i5^36r�^i:."'"�C.s1•"�:,�•@ls'2 'Y'-X''-"� K�$Ir4��Y. w�cYJ'^k�Y '4 �qs'
?Comments prefer to quesbow ) Faipla�+suty YMSA nswers ar:d/or anty�rccomaaendatinnsFar aqY other cammtentts.' ' � � 4
'[ - ',if°.P.h1 �(`'tsD"' �, i.::iF:' �"d5 L'f3! ,ti+.;a..':".'?N "1$' i.:i ." G rt``Nili' wn urE,ii+tP`.`f`'PPS>�?€3'l�4Pat�iFt4#i-a?YP!
;Use drawang tof faixtity�ta better a rla�un srtnadons. {o ddi�oaallp
�agzs€as necessary): ' ❑ Feld Copy ❑ Final Notes
#
1 '
Rlease- use weed con col ca -:per J
Clem f n c� C C� 1 i PCB
D , -� r s 1 �'l
0
Reviewer/Inspector Name 3 . �: ' 1 CPt. eltG ` ; amom� �;; ' �. w xr;�� . >.;. p?
ReviewerAWspector Signature; Date: C! c
iwi.&iva a.uiu&"urns

Facility Number: 3 - 7 Date of Inspection Q
r
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? Jes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WT3P, checklists, design, maps, etc.) ❑ Yes Z-90
23. Does record keeping need improvement? If yes, check the appropriate box below. 101Yes ❑ No
❑ Waste Application ❑ Freeboard JZWaste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes j2 No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ,.®"No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ..E No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ,a'No
28. Does facility require a follow-up visit by same agency? ❑ Yes lffio
29. Were any•additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ZNO
NPDES Perrnitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes 07 o
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
g)) "C/ea sc Ve e.. p Cu,rrerit- C'erfq. cam of (fvverQ6-e_�c
w4h pn - s 14e_. re cords . 3�C coc canrno,4- foe,
1000L-k(j Pk;ttm cuyt`�(:4- toCa l J+ W
.23� P)ease_ 4q- more � la
OLJ 04 NCJ4eMtO6,' PUM
P?/13
e.Uevi.i on e' _ TI d oued'-'aPP�)
IZ/IM3

QDivasion of Water Quality
�r t� Division of Soil. and Water Conservation
V O Oterilgeriey _•. l -'"i
S Vli
J r
ey E IIS�,��qY�
1, �.� �. •,
�';�`t3i?��,+iw 'r,.
4i.1
r's... tik
',3 c, !-
:.};F.v �-,\�;'i.t �_'. J..,;bC�:
_. .�'„tY-4L..r •r,�. a' c .;�,
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit woutine O Complaint O Follow up O Emergency Notification
O Other ❑ Denied Access
Facility Number
Dale of Visit: l/ll OZ riine: f DI->D Printed on: 7/21/200o
,3/ -]
0 NNot Operation. O Below Threshold
Permitted UCertified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold: .............
Farm Name: .e.rG........ U>rSS°� County: .......... u�%,rh........................................................
Owner Name X!1t L�!?hi5 .... Phone No:
.................................................................................. ...........
Facility Contact: .............................................................................. Title:.......................... Phone No:
MailingAddress: ...... ...................................................................................................................................................................................... ..........................
Onsitel+;epresentativc " rat°✓fit't✓...,1�!?!!/►lr�...• Integrator:...lrfr.fn.<.................................................
...............................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location'of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 « Longitude ' 4 «
Design Current Design Current Deiign . Current
111ue' ,-cupadty.. Pa ulntion,.. Poultry. Ca achy . Pa nlatip�a. 'Cattle :. Ca�seaty:..;'An� �ln?aoin
Wean to Feeder
Z(,
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity:
Total SSLW
❑ Subsurface Drains Present ❑ Lagoon Area
:;. ❑ No Liquid Waste Management System
❑ Spray Field Area
Dischaiges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: []Lagoon ❑ Spray Field [-]Other
a, if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed• did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min!
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes 1KNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O No
Waste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes %No
Structure I St. ucturc 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....................................................................................................................
............................ .................................... ....................................
Freeboard (inches): Z�
5/00 Continued on back

Facility Number: - - Date of .Inspection 1 l
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes C9 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 maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes P,No
Waste ApRlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes UINo
12. Crop type t,oas��� GN�`�-- G,he�f Stall (��4tN U.Qvsee':�(
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wetiabie 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?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
c�enc.. ... l�Ate.....
iris a�6 , f this visit.
❑ Yes EL No .
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes C3 No
❑ Yes V.No
❑ Yes P No
❑ Yes VI No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes �&No
❑ Yes 4No
❑ Yes K No
❑ Yes ® No
.,
ND li`cU J Al') 94r P[r, 4ft'r Cr,400 A ws G?me_ 2+- /.3T; bme— Aeeh • o be—
�Epf/,,got jn ►-eet, Ie✓fI eleMinIIt'd I". '5;�iAL ..Qs�I�
Reviewer/Inspector Name "� i .`.;T "„ =s � , B ZA Tim, .
Reviewer/Inspector Signature: Date: 11/1 /Q -7— 5/00

Facility Number: Date of Inspection ( f Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 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 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes R No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes T No
ttona oments an or raWings:
m
A.
5/00

Facility Number Date of Visit: '66 Thne: =Printed on: 7/2I/2000
Q Not Operational Q Below Threshold
CPermitted Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .......................
l _ l
Farm Name: .............1�...."'r�!............ County:... V��In" ................................. ....................
.............................................
OwnerName:.....................................................................................................
FacilityContact: .............................................................................. Title:
MailingAddress:........................................�(.�..,...................................................
Onsite Representative: .. ...\;,'\�v�fL
Certified Operator: ........................................
Location of Farm:
Phone No:.......
PhoneNo: .....................................
.................................................................................................. ...........
Integrator:.. ...............�...V...�a1..... .................................
............. Operator Certification Number:.....................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �6 Longittide • 9 44
Design Current
Swine Canacity Ponnlation
Wean to Feeder
rac CC}
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity population Cattle Capacity Population
❑ Layer ❑ Dairy —
❑ Non -Layer JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagmn Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact_5
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: El Lagoon El Spray Field ❑ Other
a. Irdischarge is observed, was the conveyance man-made? ❑Yes ❑ No
h. if discharge is ohserved, did it reach Water of the State:' (If yes, notify DWQ) El Yes ❑ No
c. If' discharge is observed. what is the cstimalcd flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes,' notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes MNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �jNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Number: -- 9 J(Date of Inspection � Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 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 YNo
(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. ]4.No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes X No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �TNo
Waste (\pplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes WNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes allo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
1q violafigris:or dr. jc.iencies mere noted du.ritig �his:vjsjt; 'Y'oti :Wil! r, eeeiye 46 furthgr.'
correspondence. about this .visit. . .
❑ Yes �ff No
❑ Yes 96No
❑ Yes ❑ No
XYes ❑ No
0Yes []'No .
❑ Yes �(No
❑ Yes XNo
❑ Yes b�No
❑ Yes ,KNo
❑ Yes 6-erNo
❑ Yes NrNo
❑ Yes RNo
❑ Yes NNo
❑ Yes IN No
❑ Yes N No
Comments (refer to question #i): 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):
s�Shew� �Ctr-�5Q ��\Cs���'�3%1 Co�� la-G.�li��•-�
M�AN\<� LA15A X—v V-0 Lj -P_,�� -_-�L-3
�� '�Qt,, 12t-,, G1�� yam• �..�� �, �� '�`�� hk 2�-s' � "��
Reviewer/Inspector Name \)VN V \-Q_ 14039 S 3 1 o o
Reviewer/Inspector Signature: Date: i Qd_ 5100

Facility Number: Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge tit/or hplow ❑ Yes N0'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? . . ❑ Yes [�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes I�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 pei-manent/temporary cover? ❑ Yes XNo
Additiona�Comments'an or„ Drawtn gs� h
Lr
0\'�� ( ��� �V ts
U V
�e �� '��A L
4-1
5/00

© Permitted © Certified [3 Conditionally Certified © Registered Not Operational Date Last Operated:
Farm Name: ;0`{.................................... y: :. C�................
Count .. .P.'. ..t... .....I .................
Owner Name:.....J°ti ............. ........ Phone No:
Facility Contact: Title:.....lrS ..5.. Phone No:
Mailing Address: .� �........ ...... D.'�..t.................... ................
Onsite Representative:....-.....C�-1........ L. .-- V. .................... Integrator:.''��1�,�..':1.C�..�}`T...................................
Certified Operator:.. .................
[ .�3.1— =� .. Operator Certification ...........
.......... �......i..4�
Location of Farm:
C`H1�--5::......Et.ti �1Y....5Q..-?no,ta�-t-- 1....,... �r-l�.......t'..1.t"....-i.Q.l�-..........:F�..1�-'�M........1..5......Cti.�..�.............
LSL..._0-�....5'tag.....U.�- ..1.......�:r_17N..:..x ...x .5..�..�.?....... 5..t...1�.. ....�........................ ................
Latitude • Longitude © • ©4 FCF_(Z7_«
Design Current
Swine Capacity Population
Wean to Feeder
2
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts(
❑ Boars
, Design Current Design Current
Poultry' Ca acity Pa ulation.. Cattle` Ca acit Po to€ation
❑ Layer ❑ Dairy
❑ Non -Layer IR Non -Dairy
❑ Other
Thai Design Capacity
Total SSLW
Number of,Lagoons ., # ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Ii � oldiniTonds I; Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes RNo
Discharge originated aL ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes gNo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes KNo
c. If discharge is observed, what is the estimated flow in gal/min? V/,4
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes XTo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes NrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes qNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 StrUCLure 5 Structure 6
Identifier:
Freeboard(inches): ....... -.. ................................ .................. .................................... ..... I............................. ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes (No
seepage, etc,)
3/23/99 Continued on back

Fagility Number:' I — Date of I nspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? []Excessive Ponding []PAN
12. Crop type 5.. �/VL fJ b A A, -c-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes '%No
❑ Yes 91,
o
❑ Yes Dd No
❑ Yes ❑ No
❑ Yes Wo
❑ Yes JS(No
P)? ❑ Yes ERNo
❑ Yes 15�No
❑ Yes gN0
❑ Yes �No
❑ Yes XNo
❑ Yes •KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
o yiolaficjns :or d iieieucies vtF re pQte�7 d�rrtng thls:visit: Yoi} i >�ec�iye >tao u>�tht e - .
correspondence: about this .visit. `
❑ Yes KNo
❑ Yes 9No
❑ Yes 5°No
❑ Yes 5(No
❑ Yes KNo
❑ Yes ONo
❑ Yes KNo
❑ Yes VNo
❑ Yes 151N0
Comments{refer t'o,question4): ',Ezplain any -YES answers'and/or any-recom &fidations orlany other' comments
T1Se dC3Wln winks, faClht to''betteC eX IainSituatiOD5 uSe additional'p a es asmeceSSa ` �`l { a ' , 1 �'
y I? ( p IS) i y
!. r .�` 1 : p' ktt, t- E• �. -,.t� P. a=? ...1 Y ii X �_, T (' i "�s ,e, l..> C�1. t' i
5 h irj- t C s- Cry T_ M t S ` e `C A-ra—
"-- A_ S SCE °7 a C3-t�C� W L L
t
kJ
ector Name �+
p �. l _ , /L n. �-, a .C7--1 C V' mom, t-f j l�\I 2
Reviewer/Ins
,— �,��
Reviewer/inspector Signature: [ U J . , A L_-Z ,, Date:. � (, L4 G cm
3/23/99

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, El Yes 'j�\\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 SM
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 rkNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes INO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Ko
itionh OITirh;e ltS am Or rBWlEtg,S 33' 3 (' l ` g s $3 a% p pd3 P 1
i w€. r ft, t. .. 1• =i..,sga, , .$ l ¢,,, 1. a ?.,daG€sni3i d.G€4,
_.. _. 7..
.rye � � C7 l � C�---L-� r 5 �A l�'1/� 1 `7 _ z-•L! � 1.� l� - L t� �1'J--�°cT�- l� .�
3/23/99

Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
p Permitted p Certified 0 Conditionally Certified Ip Registered 10 Not operational I Date Last Operated:
Farm Name. P.ieree.N.urspry........................................................... .................................... County: Duplin WIRO
OwnerNantc: Satn.......................................... Ennis........................................................... Phone No:.......................................................................................
FacilityContact: ...................................I...I........................................Title: .... Phone No: ............................................................ ..........
Mailing Address: ffwy.SA.S................................................................................................... Cbjaq.uarpan..N.0...... .............................................. 28453 ..............
Onsite Representative: ........................................................ ........................ ........................ Integrator•:l ar.p:hy..Family.Fatrms......................................
Certified Operator: M eKt,.:)' ............................... P.ierice................................................. Operator Certification Number: 1,7265 ............................
Location of Farm:
Latihulc ®•®� ©�� Longitude ©• ®° ®
Design Current
Swine Capacity Population
® can to Feeder
2600
Feeder to ints
D Farrow to can
D Farrow to Feeder
D Farrow to Finish
D Gilts
D Boars
Design Current Design Current
Poultry .Capacity Population Cattle Capacity Population
p ayer Ij airy
D Non -Layer D on -Dairy
1D Other
Total Design Capacity 2,600
Total SSLW.1 78,000
Presen
! Ponds dSol f�olmg. d Trays :' � 3f•E '' 3,1 i t l � . Subsurface sugruid Waste Management
. Drains_ � Y g ern ... rea p E pray re , Area �E!
.. 0 .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? D Yes D No
Discharge originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes []No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) Yes p No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) D Yes D No
2, Is there evidence of past discharge from any part of the operation? D Yes []No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? © Yes D No
Waste Collection & "Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? D Spillway D Yes D No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idesitilier:
freeboard(inches):...............24........................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, 0 Yes p No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31_784 Date of Inspection
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 maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
[]Yes
❑ No
1 I. is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
p No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewerllnspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
Q - N.o.viotations.or. •defieiencies.were.noted •during. this visiit. � at will .receive no. further.
.. c6fr'si)6Adeke: about this:visit; ............ . . .......... .
witn ULV:
freeboard available. No problems observed
is in good condition. No overtopping observed from storm, no seepage, no erosion, no embankment sliding. No
endations at this time.
Reviewerllnspector Name
Reviewerllnspector Signature: Date:

❑ Division of Soil and Water Conservation ❑ Other Agency
®Division of Water Quality
Routine O Coin laint O .Follow-u ' of DW ins ection 0 Follow-up of DSWC review 0 Other
Date of Inspection !
Facility Number
Time of Inspection 24 hr. (hh:mm)
©Registered V Certified d Applied for Pernut [3 Permitted JE3 Not Opera Date Last Operated:......,
FarmName: .............. iaxf.tK.........; +.......... .........,................ ............................... County: ........ b4 .lira.............................................................
OwnerName . .................. .<,-�o,.rva...... I ............ ....... .1 Ylx�.�............................................... Phone No:I
Facility Contact :............ 1 AQW ....:...:1:: ���. ...................... Title:....... OL....,.................................... Phone
No-
....... ?iA!..
...............................................Ll.lhx R,..Mailing Address: .....-uc.................. .......(.�.....1..Z........ ...�..{V
Onsite Representative::..........za1Aa......... ............................. .... Integrator ........... . .:...?...�...... 71umber...
....Certified Operator;..............................................................................................6...... Operator Certification.................
Locution of Farm:
........ .... .. ...... .. ............................................
Latitude Longitude �• �� �'�
Design ..', Current
Design Current - :: r : Design Current
Gapacityr.,Population„
Poultry
Capacity Population Cattle T Capacity, Population'
Wean to Feeder
2 Oo
10 Layer
JE1 Dairy
Feeder to Finish
ILI Non -Layer
I0 Non -Dairy
❑ Farrow to Wean
❑ Other
❑ Farrow to Feeder"
❑ Farrow to Finish
Total Design Capacity k
❑ Gilts.
x-.
[I Boars
Total SSLW
Number of Lagoons /Holding Ponds `'
❑Subsurface Drains Present
❑Lagoon Area ❑Spray Field Ares
, F ❑ No Liquid Waste Management System
�.
General
L' Are there any buffers that need maintenance/improvement? ❑ Yes ( No
2. Is any discharge observed from any part of the operation? ❑ Yes No,
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? r ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes JK1 No
c. If discharge is observed, what is the estimated flow in gal/min? IN
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 (1 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Q No
5. Does any part of the waste management system (other than lagoons/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? El Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes (P No
7/25/97 Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaLgoonv,floldine Ponds, Flush Pits, etc.)
9. Is storage capacity (Freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure a
Identifier:
Freeboard tft):............. 3,21.......................................
10. is seepage observed from any of the structures'?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes %No
❑ Yes 0 No
Structure 5 Structure 6
❑ Yes PE No
❑ Yes No
�] Yes ❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers". ❑ Yes No
Waste Application
14. Is there physical evidence of over application'? s' ❑-Yes (i,No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ......................... '
15. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19, Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
...............................................
❑ Yes
Q No
❑ Yes
® No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
No
IN Yes
❑ No
No.violations dr de'ficiencies*ere noted during' this. visit.- Youmill receive no further
correspondence about this'. visit'.,'
❑ Yes ® No
❑ Yes q No
❑ Yes ® No
CornmernW(refer to question #):.Excplain any,,YES answers and/or at y rec6m16e'ndatrons or any"other comments x� ,
Use:drawtngs of fucihty to: betier explain situations. (use additional. pages: as. necessary):"
1z. gyre 3�c,
t 51-wu �� rcvc�e. � . •
22. l 0{0.` ir>u- ay.r1 oa��Gnjs comtW. tovurtrryI of �-Cld 5kOUO �,e reCwCW ran` `V%
s�r� UZ`CGrCiS W�,ut.c.: tGlCr�i�iie.'�Iv1�, r\.��YOCe�f`- t�j�li+��[,fS . 1v1�Oaeti�, kx��Ci.Yl(,pS �G\0�'IU tOE?
Co�Cu��td
%e Stet -6 V-4_eP _ rn Ptr %eI b_Ai C 04 scN,rau, j i ,� d � i-c!uS ,
7/25/97
Reviewer/Inspector Name I1rt Q_ti-- •t'1n' M<
Reviewer/Inspector Signature: � � J� jN Date: T 7h AR

10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection Z
Facility Number
Time of Inspection) 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
5 Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated : ...... .................................... ...................................................... ........ ............................................
FarmName: ......... pis—T(�......... 1„ttSt:.......... .................................... -....... County:.......... \ ........... .............. ....... .......... ........ ...
Land Owner Name: ....Sa,nea....1:..1!1!115................................................... Phone No:....�? (k � �.......
Facility Conctact:...... RQ6.gy±..... Rio ................................. Title; .....�aS.C.C................
_..... ... Phone No:.���0�..�.�5`�a��o-�.............
Mailing Address:....'].. �r.......L7(.t]JS......a......._.................................................!!tL�(lAtlllurt,............................. ........ .�.rw7D..#.......
OnsiteRepresentative:...`..- ..... Q�.�Y.:........................................................... Integrator: .......'.k1f l!.............................................................
Certified Operator:... O?............ �......... ..............�... Q:�.CQ......................... Operator Certification jNumber:...... r.. S.7 ................
Location of Farm:
...`.>'.1r�..... 1?.....,at............rr.�......�.:.............�......s�rxr.�...... ��.......�...�.m.,...........,.........t�.��.......a......... ..............��...}....l�ta::.. t?
.............. `'.. ...
Latitude CIE 0 ®' =" Longitude ©• �, ®'6
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes to No
❑Yes iDNo
❑ Yes EA No
❑ Yes 1P No
❑ Yes No
❑ Yes 00 No
❑ Yes [ No
❑ Yes No
Continued on back

Facility Number: ...34 .............mq
- 6. I91bility 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
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
G'No
Strugttrres (IjUons and/or Holding Bonds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
........... .................. I......... ............................ ............................ ............................
............................
10. Is seepage observed from any of the structures?
❑ Yes
Ja No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
J�jNo
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
EdNo
A'aste APPlication
14. Is there physical evidence of over application?
❑ Yes
U No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........... X . 41AN ...................................................I.'. it,......................................................................................
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
C&No
18. Does the receiving crop need improvement?
EtYes
❑ No
19. Is there a lack of available waste application equipment? ❑ Yes IR No
20. Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
For_Certitled Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? [ Yes ❑ No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes f,No
24. Does record keeping need improvement? Yes [:]No
1$. KA{vL�3�101U"� be. rt�r�i(1;� 0.0) weeded.Cbri�z S S�o��c1 irlUi�fJ� tCL oW Wj frlr161\ t eNjn, u�lAf��t, �iS�oSG fr �n5ec
M'�roI L tis�
x . Sn rc, &k
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: J,�.7A1
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97