310800_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

Fid
Date of Visit: � Arrival Time: Departure Time: County: Region:
Farm Name: [� o,r N j Ld ZM "f"dj N6W Email:
Owner Name: Phone:
Mailing Address:
Physical Address: A a
Facility Contact: �j o%r CS !-}y ujc kT1tle: Phone: ! f U
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
n Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
Dr P.oultr, Ca acik P,a
ILavers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other FTT-urkey
Other
Turke s
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 ❑ No
❑ Yes Q�rNo
❑ Yes Lrr
q NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: al - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes _j,;0 No JP'NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): T
Observed Freeboard (in): ILL
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E;�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 EA 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 ED 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? 4
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes a No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E j No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ 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
0 Yes
[] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[R No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[� No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes
❑ No
❑ NA
� NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EA No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
S\v � I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
NA ❑ NE
❑ NA /J9PNE
❑ Yes to No ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
5!] No
❑ NA
❑ NE
i + (1 k
Phone: -1 ! b 173 i
Date:
2/4 IS

Type of visit: %,oruompnance inspection v kiperation xeview v structure rvaivation tV iecnmcal Assistance
Reason for Visit: 01koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Lh Arrival Time: �-1 A� Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: ! Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
I
I
Dairy Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,oultl. Ca acit Rio
I Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
I Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes L3 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes J No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �}'No
❑ Yes -0
❑ Yes ENo
❑NA ❑NE
❑NA []NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: G d jDate of Inspection:
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
( o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
T Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):G
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
[3NE
(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
P!(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
7,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
VNo
❑ 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 PNo ❑ 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, et71)
❑ 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 6 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 01."
No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes �No ❑ NA ❑ NE
❑ Yes �? No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �Vo
❑ 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.
'No
❑ Yes o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Tr
❑ Weather Code
❑ Rainfall [3 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ YesN
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

.cility Number: Date of Inspection:
!. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes [2-No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eno
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑NA ❑NE
❑ NA ❑ NE
❑ Yes J2-No
❑ NA
❑ NE
❑ Yes Eno
❑ NA
❑ NE
❑ YesJD14o
❑ NA
❑ NE
❑ Yes Z17o DNA ❑NE
❑ Yes ,Pllqo [DNA ❑ NE
❑ Yes �No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1:?iVo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes L2 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ YesET`N�o ❑ NA ❑ NE
C'o"mments (refe`r to question#): Ezplein any YES answers andlor any additional recommendations or any otlier comments".
' x
Use�tlrmw,ingsnf facilit to better ex lain situatlons�(gse,a ditional, .agesas necessary).
r
-�" o-C r Y-- &a L G �
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Type of Visit: � pliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: )2r1fo—utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O d Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: j% �%1j
L—
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
I JLayer
Current
Pop.
Design C►urrent
Cat#le Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D.e, P,nult . Ca acit
ILavers
Current
P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
keys
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes I'No ❑ NA ❑ NE
❑ Yes 0 '
❑ Yes ,No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued .

Facilit Number: Date of Inspection:
Waste Collection & Treatment
4. Is Storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ,o ❑ NA ❑ NE
Structure l 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 J21No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes "2`&o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [;�6o ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s)
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,E�`No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes eNo [D NA E] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes JZNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'? ❑Yes ��No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 5/No ❑ 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 r�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 2�'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes <0 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Type of Visit: 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: 2
eS&ftparture Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 3" �_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:`i9
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. P,oultr.
Ca aci
PAo
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turk e s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Ye*,-ffNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes JD"'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 eNo ❑ 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 [2-1�o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: 77 - jDate of Inspection-'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ N ❑ 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 Z No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ZNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes )?I No
[DNA
❑ 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 ❑ YesE!I^No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 7rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift
[] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes E!�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 6E!fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 0 PTNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ��o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes &N, o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 12-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes eNo
❑ 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 'C:�,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? D Yes O No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes V<o
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection: -
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes ZNo ❑ NA ❑ NE
25- Is the facility out of compliance with permit conditions related to sludge? If yes, check 0Yes [—]No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
'draw
W
❑ Yes (/� No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ONo [] NA ❑ NE
❑ Yes 16 No ❑ NA ❑ NE
[] Yes F;rNo ❑ NA ❑ NE
❑ Yes
� No
❑ NA
[:].NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
❑,No
❑ NA
❑ NE
fer to question #): Explain any YES answers and/or any additional recommendations or any other comments::
of facility "to better explain situations (use additional pages as necessary),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/1. 3 y
Phone:
Date: Z
41201

Type of visit: Q'C'ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit:_,,Q-R1rutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:%W"'Arrival Time: �"leparture Time: O County:
Farm Na Volt 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: M_
Certification Number:
Certification Number:
Longitude:
Region:
Design
.Current
Design
Current
I) Ti Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P■oultr,
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
rEOther
TurkeyPoults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes,,ffNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes J2,No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes [;Y1Vo
❑ NA
❑ NE
of the State other than from a discharge?
T
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
_Waste ,Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [;rN ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ENo ❑ NA [3 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes J:]- 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 A�o
❑ NA
❑ NE
maintenance or improvement?
Waste AP lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes..fn'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 2Ko
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Zallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes eE2-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑�Io ❑ NA ❑ NE
❑ Yes 7 No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .2�M ❑ 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
❑ 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 , f7R o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o
s ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDateof Inspection:
24. Dili 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 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 No ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Po ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o
❑ Yes'Z"No
❑ Yes/P0110
❑ Yes 2rNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 'o No ❑ NA ❑ NE
[] Yes XT,
o ❑ NA ❑ NE
❑ Yes EyNo ❑ 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).
6r 7 3
Reviewer/Inspector Name:
- T'
f6A .sWbrr•.4�-J,c.
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ?�
/4/201

L
f Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access /!
Date of Visit: 0 Arrival Time: - R Departure Time: County: 6_ Region: W`
Farm Name: G - Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 06('�65 Ike n ct Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = i! Longitude: ❑ o = , = 11
i*rf;r, .; ,, az. Design �ztCui'rrsenaat �' �Desipgn$(x, CurrentyItq 3 DLesagn Currenty
ti 4k 4'«� k -Y-•1 � #i .*.
SwiiteE g;'
C�pac ty Pop�ulatron � Wet�Popity,
pt�apacity Population g$$p Caft�le Ca ae�tY( PyoRnlati�on,
lu
Wean to Finish
❑ Layer
El Dairy Cow
e
E,j El Wean to Feeder
4: ❑Non -Layer I
El Dairy Calf
❑ Feeder to Finish
�; ,, 1, ,, :��
f tit + ❑ Dairy Heifer
:;
❑ Farrow to Weans
pkDryPoultry
❑ Farrow to Feeder
`' i' "'�
* ,�',,}$ • ❑D Cow
P 4� `'° �
El Non -Dairy
❑ Farrow to Finish
❑ Layers
,
❑ Beef Stocker
i'
❑ Gilts
1.
❑ Non -Layers
El Beef Feeder
❑ Boars
El
j ❑ Beef Brood Co
❑ TurkeysTJ El Turkey Poults
❑ Other El Other
Nurn of Struetures�
t`cb{(yJj3e�pyr
/ y
ig f R a.',
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?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
dNo
El Yes
d
❑ NA
❑ NE
❑ Yes
3ZO
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection 'Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structy�e I Structure 2 Structure 3 Structure 4
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): AL
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes, No
❑ Yes ❑ No
Structure 5
❑NA ❑NE
❑ NA ❑ NE
Structure 6
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,.0"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes '1!'3 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 ;20�o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Po ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes _;5410 ❑ 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 ,LEI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes �N.
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes .lam No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes _.P�No
❑ NA
❑ NE
. uco rem � FkAj--P, uo"�- //%
ff er c.J cir)_- 1 s c,.- Lkh
Reviewer/Inspector Name t `, `� �� r Phone:
Reviewer/Inspector Signature: / l+ Date:
Page 2 of 3 12128104 -' Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes (ZNo ❑ NA ❑ NE
❑ Yes ICJ No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ;;rNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PKNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
;I&o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,ir/J No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
/No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
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
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
jg2o
o
❑ NA
❑ NE
Additional Comments and/or Drawings:,
r �.
6" )1 f
Z-ry Wets
— w rrett44D 2, o �o
5­7
I
[
Oki
-4o
U r -for c3 o L b
Page 3 of 3 . 12128104

Type of Visit
Inspection
Q Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
,Compliance
V Routine 0 Complaint
0 Follow up ' 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: i �' tri Z o S Arrival Time: 41 3 o Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: l��aLF�FrLt �'�iALI�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Nean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= e 0 6 0 Longitude: = o =1 = 1{
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I I ---d
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: [:::]�
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence.of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LJ No ❑ NA ❑ NE
❑Yes
El No
El NA
❑NE
❑ Yes
[]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ILj No ❑ NA ❑ NE
❑ Yes PTo ❑ NA ❑ NE
12128104 Continued

Facility Number: -- p Date of Inspection ! ��
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i A 6-o-p !
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E5 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
Cl Yes
ffNo
❑ 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
�Mo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
to
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Lj'<o
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
+ No
❑ NA
❑ NE
maintenance/improvement?
/
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑' 13� O
❑ 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 Dritl ❑ Application Outside of Area
12. Crop type(s) f3 C >Lr^ , 60 n-A ( 14 ,Sy
13. Soil type(s) AL)Tv-q yri-Lc
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No'
El NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination s❑ Yes
E3-1 o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
2 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Id'NO ❑ NA
❑ NE
Comments (refer to queshou #) Explain any,: YE5 answers,and/or any recommeidati ons+or an'y>othcr`comments�
a t w .� «� t is
tJse+drawings of -facility to better explain srtualItions t44.(uac add�teonal pages psy necessary)ry „µ i
oeDAT& UL4
q�i C: t� r° wry
hi+, N .i TtAL
A rTkV - I R-RT.P,JFAU.,-W. Tli
,�jJ56X �r�a
Reviewer/Inspector Name
--Q� Y
{i�L�
Phone:
Reviewer/Inspector Signature:
Date: 1 Z oy
r 711Yeinlf

Facility Number: —7 Date of Inspection
Required Records & Documents ,_,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? El Yes ,ICJ NNoo El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ltTNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers El Annual Certification
El Rainfall El Stocking Crop Yield Elr 120 Minute Inspections Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 01�o_ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 91Fo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No B'9A
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No 2-9A
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ Nr' ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No El -<A ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�--,
Q-tvo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
QNc"
❑ 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
alo-
❑ 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
Q-1�
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
tr No
❑ NA
❑ NE
AlditionaFCommentssand/or,::Drawings
12128104
12128104

Facility Number
1-0-envision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 9.06Mpiiance 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[%d Departure Time: County: / Region:
9
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
e_j"-c
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = g = Longitude: = c = g = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�. ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design , Current
Cattle Capacity Pooulation
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
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 /MNo ❑NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
O No
❑ Yes
PNo
El NA
❑ NE
❑ Yes
Vo
❑ NA
❑ NE
12128104
cont,

>Kacility Number:. — Date of Inspection
42*
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 DINO
❑ Yes U(No
Structure 5
❑ Yes [/No
❑ Yes /No
❑ NA ❑ NE
El NA ONE
Structure 6
El NA ❑NE
❑NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑/ o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9'No ❑ NA ❑ NE
maintenance/improvement?
l I . 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,2ko
❑ 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
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
��I No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
r I No
❑ NA
❑ NE
Reviewer/inspector Name "° ;.: "- �, � `` Phone:
Reviewer/Inspector Signature: 4 Date: y
Page 2 of 3 12/28104 Continued

Facility Number: — Date of inspection
Recjuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Pio ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [ 1 Yes L'No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El 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 ❑ 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
2No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W"No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
?No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RMo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�1Vo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[{ Yes
[,�No
[I NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,_,
L�J No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
;ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Atldttlonal Comments and/orr])r�awings.
i
��� � Gib'
� • � �'
�' ��� G�=� f
13
ZI
Page 3 of 3 12/28/04

i `n of
. `D visio o Water Quality
Ractltty Number. �D fO Division, of Soil and Water Conservation
„3 Q Other Agency
Type of Visit je Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit JO Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival 'time: O-Departure Time: = ounty:
Farm Name: /�5 `�('OC f:2 Owner Email:
Owner Name: l`O CY Phone: _
Mailing Address:
Physical Address:
r
Region: IIt�
Facility Contact: Title: Phone No:
Onsite Representative: _ 'IwA2 5 �' C Integrator: llR�f �.L'2QCr..J�
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 ❑ 6 Longitude: ❑ ° ❑ ' ❑
Design Current: Design Current Design Current
Swine Capacity Population Wet,Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
Wean to Feeder
121&019
S
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer I_ .. _..I
i
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ko ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
,KNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Faeility Number: ) - Date of Inspection '7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: /00
Designed Freeboard (in): lqs5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ff No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ,INo
❑ 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 10 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 X,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 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments..
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
2-006 AM
6"
Phone: jJ
Date: _ AIRAR� A
12128104 Continued

-cx
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X
No ElNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LdNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZlNo ❑ 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 gNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No ZfNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )eNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes f�No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
/
❑gYes No
r
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes Of No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 9No
❑ 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
[__1 NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/`i
32.
Did Reviewed]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes �_IlNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes 9No
❑ NA
❑ NE
Additional Comments and/or Drawings:
I�o4210,
Page 3 of 3 12/2VO4

Type of Visit r Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 08outine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: U Time: /+
O #ot Operational O Below Threshold
© Permitted 13 Certified 12 Conddjitlonally C reified J3 R ' te`red Da Last Opera or Above Threshold:
Farm Name: �i> . J!�..'r ounty:... ..y�» ............... ».» ... _..
OwnerName: ....... ....»...»..........»....». �...... .....» »» ...».. » . ......... .- ». • Phone No:
MailingAddress:.._. ...».».»..................»W...»........................ _............ ».... ».»..»»..»... .»».».....................»....»»..»»......... ».. .........
Facility Contact: .._ ...... ff�� j�.,...... N .... »/»». Title: ..._.. .. _._ ._.. __ Phone No:
Onsite Re P resentative:.. S,CYlU1� _.» Lrl......».»...».......... Integrator:., /..» L . .........»w ..... M....... »..
Certified Operator ...».......... ........ ............... » » . ».. .._ .... » »» .»... ....- ....... Operator Certification ber:.»»»..
Location of Farm:
IV
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude • '64
- Design C;
Swine C'anaetty •,Pni
Wean to Feeder
Feeder to Finish";
❑Layer
❑ Non -Layer
Farrow to Wean
Other
Farrow to Feeder
Tofa!'Des
Farrow to Finish
❑ Gilts
Boars
_y.
-.: Hnldr
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ETNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes z'lo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes -E3'No
Structyre 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches): 3X-�
12112103
Continued

Facility Number: , ?7 Date of Inspection , 34
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion,
❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes ,ETNo
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 ,fCNo
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
❑ Yes 2<0
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ZrNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes 2-&o
❑ Excessive Ponding ❑ PAST H draulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type t/ ' a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CXWMP)?
❑ Yes )ffNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 2 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 )2 No
16. Is there a lack of adequate waste application equipment?
❑ Yes �Wo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ yes 0.<o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes 21!0
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes' 040
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 0<0
Air Quality representative immediately.
:?F,.€�"J/i$E°l:i::9hE Y"'°�Hd"""•1Pliif4Htf'f �sf3'Y'it.l;` •: t�Wlt :"h➢','4tE."'�iiFe?i. �P3ddlPfE£#ii'76ii�Od';€itlilf:�••>,••N.P€d&21�(9id.'RQa.d:l!`itt�..ii�''il'%cd 3-•:.•:i}ln:
f,Camme i (refers,tti gaeshan #) �iE�tfainiauy YES aoswers�,aad/oraay re,,,,"6 6A"0nss,0r,sa "per,
urs?[' ". �8gj.0 `tr 1:e'3i':tl' Et€ . 'N.81�# f�11 I�If" MtC�` 4t �xt €Ht€y;Pl sl ..;c:>:
Use drawiag�:oflfaeto better:ilaux'sitaatioas. {aseaciditio! Pages'�as �r�');i
[ } �p (� �1 Field Copy ❑ Final Nous , ,�;
rku�rs � .�..?a as s. r.. rt.. : [S # , 1 a- pii.'diii`�> iau .fi,.. r,.daut. 3r u.�.. ,:.: ,..§'.: ;�ri:,.:a.;: it 1 3]s-IiKrit3. .
-� e car s Gt/i�, lwl - %,ez �Cxreor l--f
Reviewer/Inspector Name €o1i ! . a3�o ,r' - �,x i 4 ,, } ` } t
Reviewer/Inspector Signature: Date: li
12112103 Continued

Facility Number: — Date of Inspection ti '
Regulr, d Records & Document;
2i. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes .ETNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes jD-No
23. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Waste Application ❑ Freeboard RJ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ;3No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONO
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes '0140
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes QNo
28. Does facility require a follow-up visit by same agency? ❑ Yes 1>90
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 214o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes Ja No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ]--]No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

pe of Visit OO Compliance Inspection' O Operation Review O Lagoon Evaluation
Reason for Visit OO Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 $00 Date of Visit: 411112DD2 Time: 3pm
Q Not O erational O Below Threshold
Permitted 0 Certified 13 Conditionally Certified C3 Registered Date Last Operated or Above Threshold: ...............•
Farm Name: ..............................................
Owner Name: Clinks ................................... .A,yeacli...................
....................................
Mailing Address: 1Q2.4..CyPr &.Cj: J:.kRd..........................
County: l),upUrl ..............................
.................
Phone No: 2.1Q-285-A2.G8...........................................................
W..allace.BC.......................................................... 214.66 .............
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Onsite Representative:ftmgr............................................................................................ Integrator: Muxpby..la.t1]Ittily..lF&rms.......................................
Certified Operator:.Chnrka.................................. Ays.Q& ............................................. Operator Certification Number:,�2.15.8...........................
Location of Farm:
East of Pin Hook. On North side of SR 1830 approx. 1 miles North of SR 1827.
® Swine ❑Poultry ❑Cattle ❑Worse Latitude 34 ` 45 30 66 Longitude 77 • 44 sF 0 66
Discharges & 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 gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Stricture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................1.............................................................................................................................................................................................
Freeboard(inches): ...............32......................................................................................................................... ........

Facility Number: 31--800 Date of Inspection 1 4/11/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 2 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
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload] Yes No
12. Crop type Coastal Bermuda (Hay) Fescue (Hay) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified (Animal Waste Management Plan (CAWMP)? ❑ Yes 0 No
14. a) Does the facility lack adequate acreage for land application'? ❑ Yes 0 No
b) Does the facility need a wettable acre determination? ❑ Yes 0 No
c) This facility is pended for a wettable acre determination'? ❑ Yes Z No
15. Does the receiving crop need improvement? 19 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 or other Permit readily available'?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
C9 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
0 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Z No
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Z No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Z No
24. Does facility require a follow-up visit by same agency?
❑ Yes
[K No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 9 No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.

05103101 Continued
Facility Number: 31-800 Date of Inspection 411I12002
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 9 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon`? Yes 9 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 0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'? © Yes ® No

,r, �_a.� i Sit
blvlslon Of water Quality, �' ' �� '
Q Division of Soil and Water Conservation
r ' i, O'Other Agency
hi Ll
Type of Visit 10compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for VisitleRoutine O Complaint O Follow up Q Emergency Notification O Other © Denied Access
Facility Number j a Date of Visit: If Time. /Z.50 Printed on: 7/21/2000
0 Not Operational Q Below Threshold
Permitted [] Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
�e3 GaC ►` a dt"s� Count !p
r
Farm Name: r
Owner Name: G�q�les A�GoG
-..........!`..................................................... Phone No:...........................................
FacilityContact:...............................................................................Fitle:........................................................ ... Phone No:
MailingAddress: .............. . ................................................................
Onsite Representative: .... �pl� �, d�f„••,•-Q•,•�G
Certified Operator:.. .................................................
Location'of Farm:
Integrator: n-l>f7Ph
ff....... .................
........................... Operator Certification Nu
...........................
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude C�0 4 41 Longitude • 9 44
i Design
Current Design Current Design Current
s,, : aciPo
>s..._._...>...._.:.,...
Poultry attle
Ca aci Po ulation C
ulaton
C.r_ Po latonCa
`? Wean to Feeder
Layer Dairy
Feeder to Finish
❑Non -Layer Non -Dairy
Farrow to Wean
Mg
.i=• Farrow to Feeder
❑Other
Farrow to Finish
Total Design CApacity
Gilts
Boars
Total `SSLW.
N �4Nei#itbetr pf Lag66fi
f
❑ Subsurface Drains Present
❑Lag-nn Area
❑ Spray Field Area
Holding Pon/ Solid Traps:,
❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )dN0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ;Z'No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes fi�rNo
c. li' discharge is observed. what is the estimated flow in gal/min? -n r a
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes �TNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ANo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )E�No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes)2NO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier; .....................................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Number: 3 -610 Date of Inspection ?� Q
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes dNo
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 /d No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
elevation markings?
)ErNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload
❑ Yes lEfNo
12. Crop type $e_w -It V GC4 .Si�n,ct. V( G N4 v't
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes f2rNo
16. Is there a lack of adequate waste application equipment?
❑ Yes )IrNo
Re wired Records & Documents
I7. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes JZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes No
(ie/ WUP, checklists, design, maps, etc.)
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 ZNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes PfVo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes 0
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ,ErNo
24. Does facility require a follow-up visit by same agency?
❑ Yes eNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 0No
YiQ1Pii9nls Rr dtr1clepci t,5 4 're poled t rtg }s'visit; Yoh wli ee i e o f1u4't� r
• cories deuce: a�otit: this visit: • •
Commeats (re€er to'question #); Em lai> any YES answers and/or any'recomme6dations or, any other comtnenis.
Wit' , t. i "r 1 �� } -- e i -'i Y s (F i'i 1 ih " - P i_ i. ? t t y. . Y `- f A , P4
.
Use drawinga„ of facility.to' better explain situations (use additional i pages 8S necessary} „ # . IE< I",�; i, s ;"y
! P.
• �1ee0t 40 we we, S'e, oth.ad W 0 4o,YS off' catlar% A.FZ.V E''1�S 6vi --Ile Z IZ n - Z, � �s, � 14ow e -f rec b, ev-d ie c o nt aV o,1 J a 61i �e -re'.
�►1see d►v��e -�eld�2��e� q���a( �C��p
at G o�,�(yl VS2 p.^O ,per'' �GreG�e, f
4p soli 4e_0 reGflrww►�vt.aLa ;onsc
Ni4e: TaG{ jT4,1 anal. cfer-f q-r e hea4 !,� ker
Reviewer/Inspector Name a.Gth/ .A r l� f °
Reviewer/Inspector Signature: Date:

Facility Number: ] — p p Date of Inspection l z Q
Oder 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 1KNo
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? ❑ Yes11�INo
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.) ❑ Yeso
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes /2rNO
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes ❑ No
etiona rmgs: raw,�.1 rd.' ;.�ti 5.•t.: r, r•, �� �'F ,�+ { t :� ' €
A6
r

g>,Division of Water Quality
0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit `QFCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit V Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number GD Date of Visit: —GO 'rime: 3 d Printed on, 7/21/2000
Q Not Operational Q Below Threshold
(] Permitted Certified 13 Conditionally Certified 13 Registered Date Last Operated or 1Above Threshold:
FarmName: ....... '..�TJ. ... ��,v '' ... a .......................................... County ........ Y .!>.................................................
OwnerName: ............................. ..................... ........................................................................ Phone No:.......................................................................................
Facility Contact: .............................................................................. Title:..................... .. Phone No:
............................................................................................
Mailing Address
Onsite Representative:. i............................................................................. Integrator: ,..... �.....
......
..........
I.........................
Certified Operator: ................................................... ............................................................. Operator Certification Number:...............................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��° Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder X03 JE1 Layer 1 ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Soars LEI Total SSLW
Subsurface Drains Present ❑ La r
min Area Spray Field Area
Number of Lagoons � _ _ P Y
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imuactti
1. Is any discharge observed from any part of the operation? ❑ Yes X No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance ratan -made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of (lie Stale? (11' yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed. what is the estirrtated flow in gal/thin'?
d. Does discharge bypass a lagoon systent? (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 M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J�tNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... ........................................................................................................................................................................................................
Freeboard (inches): 3 a-
5100 Continued on back

Facility Number: — 6d 1 Hate 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 gNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes gNo
W-,iste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ZNo
11. Is there evidenc of over application? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload ❑ Yes b&o
12. Crop type 10
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?
P.
�Vo.0Qlatitt?ris:oi- Mcienc#es •mere h6 ed- ditrifig � ;is:visit; - yop i#1 reeeiye hd fui-th& - . • .
. ' - • corresp oriden& about. this visit
❑ Yes J'No
❑ Yes XNo
❑ Yes ❑ No
9Yes ❑ No
❑ Yes ❑ No .
❑ Yes XNo
❑ Yes K No
❑ Yes XNo
Yes N
OF —
El Yes 14No
❑ Yes VNo
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):
rp—L t`
f W�QVjWku S
[]Yes jj?'No
❑ Yes b(No
❑ Yes [XNo
❑ Yes D(No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: s/00

Facility Number: Date of inspection I`L I1`1 I Gl,�� Printed on: 7I21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 5Vor hplow ❑ Yes JKNo'
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 VNo
roads, building structure, and/or public property) IT
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 o
32. Do the flush tanks lack a submerged fill pipe or a pei-manent/temporary cover? ❑ Yes ANo
Additional
" .omments art orDrawings:
r
Vie
out'-O
AJ
5/00

• 0 Division of Soil and`Water"(
0 Division of Soil and,Water'(
JaDivision of Water Qu'adi
hty'=
Other Agency = Operago>n.N
ei ation - Operation:Review
Rf
ervahon .Complianee Inspection.! ; 3
ipEiance Inspection
w,
LWRoutine 0 Complaint 0 Fallow -up of DWQ inspection 0 Follow -Up of DSWC review 0 Other
Facility Number Date of lnspection
Time of Inspection 24 hr. (hh:mtn)
Permitted Acertified © Conditionally Certified © Registered 113 Not Operational I Date Last Operated.
County: .....L7.C-a.I?.....
Farm Name: Co'}e!I�.LZ'Cll.,1-i......Vh.0 ?..L�...r....L........... �-.....h...........................................
Owner Name:.... ..................................... Phone No:.............�?......Li-.7..�..........
Facility Contact: .............................................................................. Title: . Phone No:..
Mailing Address: .W-_2..�'...� `�..�.�.Z .�..S.....b_,L'C.V—....b—D.......... L..3... A.L. l -^.C, Z.7"-,-1 k..C,....
Onsite Representative:........t7.tA..t).Lti..L,..'i.-.g..............�Q..1~.:.j4,................ . Intcf;cator:..!Ylla{.�..i:'-7)-..P....It.... ...................
Certified Operator: ... (,-,.L4A..... .%�.S-i�.0 Q.CY,,,,,,................ Operator Certification Number:.,XC;J..G.A.Z.............
Location of Farm:
-1.....S... X).0........ C.-P......5.1-.4 A. .3. ...r........:.1.. �.....r _.t.s ram..... .� .S,T:.... ..........
,5i--.)......... .1..12�.... 1_71...... ................................................. ....................... .......
Latitude Longitude 'Z —1 • ©` ®"
Design Current Design . Current Design Current
Swine Capacity Population Poultry Capacity Population' Cattle Capacity Po ulation
Wean to Feeder 0 :. ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer 10Non-Dairy
❑ Farrow to Wean :
'. ❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish
Total Design Capacity 'ZE Q
1 ❑ Gilts
❑Boars t Tota1:SAM
o'Lagoons , ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
�<
„ ! olding'Ponds /Solid Traps ❑ No Liquid Waste Management System : H I
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation? ❑ Yes KNo
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 Witter of the State? (If yes, notify DWQ) ❑ Yes R No
c. if discharge is observed, what is the estimated flow in gal/thin?
d. Dues discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes )ELNo
2. Is there evidence of past discharge from any part of the operation? XYes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WNo
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:
. tt -
Freeboard(inches): ...... �. Q............................................................:.I................ .....................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3/23/99 Continued on back

Facility Number:- I 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 KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any oi' 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 KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ANo
12. Crop type CJ 1 5,-_ P �­ ( ,-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
WNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
Wo
c) This facility is pended for a wettable acre determination?
❑ Yes
XNo
15. Does the receiving crop need improvement?
❑ Yes
XIN0
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Reuuir•ed Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ANo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
-RNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[�VO
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
U�No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
01,No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
r—KNo
(ie/ problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IR`No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
'ETNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�KNo
0: Rio Yiolaiigns:or dgficiengpe Wgrp pQted do• ing 4his'visit:• ;Y;op :will teeoiye ri6 fu>rth+gr
' c6rresp6Tiden'ce. about. this .visit..
Comments(refer to griestion #): Explain any YES answers an'd/or4 any recommendations o.any,other,comments (�
ilse,drawings of facility to betterezplarn situattoits` (use atldttaonal:pages,as,necessaiy)
z, L �-o o r, ct, A s "P7 l<0o b I o V3 `e c Le V--,1��
IT—
s r-o P C t S
17)-`C_-'� 0 v L h 6— T-h--C �_ s A -r
.y rre""C: ""f
ector Nance
Reviewer/Ins i� ` �, d9r
p t < Gtl ° 4,
Reviewer/Inspector Signature: t�A �� _ ��Q r A r. 1, Date: L 1 k '4 C) C�
3/23/99

Facility Number: — Date of Inspection
r
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 'NYes ❑ 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 ;KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 5eNo
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 N0
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 JRrNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 5N0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? xYes ❑ No
Additional ommen and/or rawings:
A�J
3/23/99

d
Division of Soil and Water Conservation ❑ Other Agency
in Division of Water Quality
W_Routine O Cotnclaint O Follow-up' of DIVQ inspection O Follow-up of DSWC review O Other �
'www
Date of Inspeciiott
Facility Number 3 Lb `
Time of Inspection ({ 24 hr. (hh:mm)
©Registered M Certified © Applied for Permit' O Permitted 0 Not Opera Date Last Operated: •„••
FarmName:........................1 t.nCSer�l.......................................................... County:......U�.�i^............................................................
r 11
1
Owner Name: ...................... CxqM:.j 5i ............ Nf—er"K........................................... Phone No:..1v5.! a�z :.............................................
Facility Contact: ..........................:............................ .. Title:.......................... ....... Phone No:
Mailing Address: ....... i C? ` .......... .�.1vC SS.....Uu1 ......` d. ..................... ..... ................................... !.4.6k.......
Onsite Representative:.........:...�.kV S........r .L'.G?C i� .......................................... integrator: .....M.t n( ..........................
Certified Operator--... ......................................... : .... ............................................................. Operator Certification Number:...................
Location of Farm;
Or....A�c?.............i..R....s� �....�,......�.1......�... tar►.i I.t1Q`a.... Ct ...........t..................................................................................................... A
.. ........... w
Latiitude Longitude �• �� �s�
Design ,,: CurrettE
Design Current• Design Current
.Swine- .`
Capacity Population
Poultry ` =Capacity Population 'Cattle "Capacity Poputation'.
Wean to Feeder
(,
Layer
❑Dairy
❑ Feeder to Finish
ILI Non -Layer
a
❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
k
Total.Design Capacity
❑ Gilts
❑Boars
r Total SAW
Number of Lagoons / Holdtng Ponds ° ��
❑ Subsurface Drains Present
❑ Lagoon Area IEISpray Field Area
AS -h
=`
❑ No Liquid Waste Management System
r
General
L Are there any buffers that need maintenancelimprovement?
❑ Yes
E�.No
2. Is any discharge observed from any'part of the operation?
❑ Yes
'p 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 Surface Water? (if yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/ nin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
] No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoonstholding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97
Continued on back

41 Facility Number: 3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Las oons,11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
............................................................................................................:......................................................................................................
Freeboard (ft): ...........Z�g...............
10. is seepage observed from any of the structures? ❑ Yes N No
11. Is erosion, or any other- threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintenance/improvement'?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13, Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type..........LDS.G.l�4- ....................0 � ►!`..... ......Y.. ::........�.?. T1 A.. ........................................................ ........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWaMP)?
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'?
0 No.violations or deficiencies. were noted during this. visit. You.will receive no further
correspondence about this visit: ',. .. .
❑ Yes allo
Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes No
,Yes ❑ No
❑ Yes $j No
Yes No
❑ Yes ® No
Yes ❑ No
❑ Yes No
❑ Yes ( No
❑ Yes ( No
Cnents:('refer to questipn #): Ekplain any YES answers and/or` recominendattons or)any oth n>uter comments:
Use drawings of facility tobetter explain situatitias (use additional pieg".ds necessary)
il. �cK 5�fl`1 0h inn (r7A S lOv e i�$PC f�l. (y - dKS �i�%�11I �y Yf� A�!{jfiJ� A.
Id_ �zccUC-- s�.o�l�� �� ;.�.sec��eJ i�• �,,Li` ��`, 5����-� S�o�lc� � �t��c.� G-s Sir. as
42-. S�Yn,Y ytCAs r 'elr� t s�.o�lc� b� � f -1 sP`a1 Ict"u- `i' etJ nLW�)ov?
us - co_y r_r_ AereA` es c. -t aY.�. ttJ�cn�- C tct1 �, o ,e�, �e fie. vlc es .
lti irY`����Glr� YY>op � ��C) _ Ir Pll�v.• L,a varti ��S'[�� `�f`�GYYY�txflCt- ,► 44 } �, I �ItHv
4-a, � ;�. t��r Ja .w 5�r� t1a , tJUO
7/25/97
Reviewer/InspectorNasne
Reviewer/Inspector Signature: �,�,L_ _ Date:

1
�.��hR M
v
3
h� �°f�� L �.�`�lF j�. �.� ��Y��..i .'P�'.It ., ��R`✓�Y #X''�` ,� �i' ,5p{c ? -
i
DSWC An ma1'Feedlot Ope ition.Reviewj
4 g
�
3.
6
S ® DWQ :Animal Feedlot 0" ion ite4ft's—
ctlon
i
g
Routine 0 Com laint O Follow-up of DW2 inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 3 Time of Inspection t p [,1fl 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
.Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
f.....f..........`... �................................. ......... ................................... �......._.................. .......... _.......
�t,QFarm Name: ........ ,a� �.......k..... . ......... s`. 1 �....... NtIA-5l.. County:.....p4A ........................................ .......... ......... _.
Land Owner Name:..Qr.�..................................................... Phone No:1al° UT-.A.219 .........................................
Facility Conctact:...... C-I. .14 AL'S..... W
dy.,_..................'............ Title: ..........Lgfe4T1�14..................... Phone No: ..t.`�14%.�:��:.� 62.............
MailingAddress:......... ....L ...�...�f �.......................................................».�t.{�{,�..y...N.�................................... Z.&.........
Onsite Representative:...... ................................................. Integrator: ...... i.hCaN/.............................................................
Certified Operator: ..CLr x.te S....................... ... f.��(�.n ak......._...................... Operator Certification/Number: ... �.7...�..�...................
Location of Farm:
Latitude I �U • ®6 " Longitude • 4 ®64
Type of Operation and Design Capacity
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?
S. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/47 maintenance/improvement?
❑ Yes 9No
❑ Yes 10 No
❑ Yes ER No
❑ Yes No
❑ Yes 159 No
❑ Yes CU No
❑ Yes Ca No
1AYes ❑ No
Continued on back

. Fari}ity Number:........ �...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
».. .... ... . _....._ ..... ............................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes M No
❑ Yes CO No
❑ Yes 3 No
❑ Yes ® No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WM{P, or runoff entering waters of the State, notify DWQ)
15. Crop type .......... ...S_SLV.fe...... ................... ......... .......... .......................................................... ............ ....... .........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? .
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes
IN No
❑ Yes
El No
14 Yes
❑ No
❑ Yes
I@ No
❑ Yes
&No
❑ Yes
BNo
❑ Yes
& No
❑ Yes
® No
❑ Yes
EiNo
❑ Yes
E,No
❑ Yes
& No
❑ Yes ® No
❑ Yes EZ No
EK Yes ❑ No
Comments (refer to giiestion #)
y l) hEwconmendations orany oter comments Explam'any`Y
Use drawingsoffailitto bettrpauiouse additiona�pagesa§necessaryeexm }{
5• Sma36-4
jhVJtr 5k4,)fa be ►n5�k(Uj s � �. C orn)r a� S?q� Reid -.WZ , V-4LkP
t Z. C �Ci�Y` _ iyy S�u�U -iIO-� r'GfnO+rpf! ,,11�~f'�otY� �ffLI . f', /?
�� �Q I`1UYr. fS pia Yl'la. k VU .Lash,. L144 i�� V� lr. 'S T>•IrrCd
fcctar�� S�nou�c� (ate rtwt7f�. U �aYt w�sfc r�no fhls;�. C�iU�
shy t� �1�.��-� lo•� �'rn`"( t' "l
%UrQ�y � r . a�au� t��flfi�oiT�Oh 1r Sysf Cyr.
cc: VIVINton of water Livattty, water Lfuanry aectton, Factuty Assessment unit 4/3U/97