310868_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Type of Visit: Q Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: p Routine O Complaint Q Follow-up O Referral p Emergency p Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: OUp
Farm Name: Y pAE, �,,,o�V I L iu-• Owner Email:
Owner Name: Re f Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region:&
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
C•unrent
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
airy Calf
Feeder to Finish
De, l:oultr,
Layers
Design
Ga aci
Current
P,o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
LEher
Turke s
rke Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 g<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
D NE
❑ Yes
[—]No
❑ NA
❑ NE
[:]Yes
to
❑ NA
❑ NE
[] Yes
To
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment '
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ell< ❑ 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 Dj<o 0 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 P40 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes UXo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ]o ❑ NA ❑ NE
maintenance or improvement?
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [JNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWNIP? ❑ Yes LNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes �b ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes GD,4 ❑ 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 p o ❑ NA ❑ NE
❑ Yes ©o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ea"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
B 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
E140
❑ NA
❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
E Io
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F24o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: ta
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3—N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EoXo' ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes R:�W ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No EA ❑ 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)
3 I. 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 B-Iqo ❑ NA ❑ NE
❑ Yes R3 lXo ❑ NA ❑ NE
❑ Yes Q-<o ❑ NA ❑ NE
❑Yes D o ❑NA ❑NE
❑ Yes O''l<lo ❑ NA ❑ NE
[—]Yes D. ]o ❑ NA ❑ NE
❑ Yes ]o ❑ NA ❑ NE
Comments (refer4b 'question #): Explain any YES answers and/or any, additional recommendations or aoy",,otlier comments.
Use drawings of facility3,to better;expla�o si#uatlons;{use adirt�oual pages'as necessary):
M!M m
0 !
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 51t) 79 IM
Date:
2/4/ 015

(Type of Visit: 0 7Routine
pliance Inspection U Operation Review U Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:o� County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: P&G G � C�rjeP �i l � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
b
0Q_
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Latitude:
Pullets,
Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Phone:
Region:
Certification Number: t 'K o a 6
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes ❑ ❑NA ❑NE
❑ Yes YJ ,V ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O/No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes 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 dNo. ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNy❑ 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 0 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo ❑ NA
❑ NE
acres determination?
N
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Zo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of inspection: 3150
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ef"❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesVNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No . ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ff No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes EfNo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes To ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other.comments: A
Use drawinns of facility to better eznlain situations (use additional Dues as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Date:
214120
—)%V

(Type of Visit: W CrRoutine
lance Inspection U Operation Review [) Structure Evaluation U Technical AssistanceReason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access .�
Date of Visit: S / Arrival Time: © Departure Time: ® County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Integrator:
Certification Number: 6
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
_Current
Design
Current
Swine
Capacity Pop.
Wet Poultry
C*apacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I
INon-Layer
Dairy Calf
Feeder to Finish
Lpo
.59e;�
Dairy Heifer
Farrow to Wean
Design
Current
Farrow to Feeder
wmyjP,ouIt ,
Ca aacity
Pao
_PryCow.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes �No'
[:]'NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: `5 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3No ❑ 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
[I —No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E:fNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ffNo
❑ 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
D Yes
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
]�No
❑ NA
ONE
maintenance or improvement?
f
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E5'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E j 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
El"No
[DNA
❑ 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 ❑ Check] ists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ 1 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
r�No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Fatiti Number: jDate of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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?
❑ Yes [fNo ❑ NA D NE
❑ Yes ❑ No [;[-N-A ❑ NE
❑ Yes [fNo
❑ Yes [] No
❑ Yes l._ 1 No
❑ Yes ONO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes dN ❑ NA
❑ Yes �NoDNA
❑ NA
Yes
❑ NE
❑ NE
❑ NE
..v...... v.r .. vr........ ........... ...v. 7 [ [D
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

ems ✓
� Division o'f Water Quality
Facility Number � - g g 0 Division of Soil and Water Conservation
© Other Agency
r
peofVisit: Cpliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
ason for Visit: Q) Routine Q Complaint Q Follow-up Q Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:,DAT Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 7E C'C'q C*1fhP(3'CU-'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: ,�� //
Certification Number: 1;s OP0
Certification Number:
Longitude:
DesigA Current
Capacity Pop.
Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design
Cattle Capacity
Da' Cow
Current
Pop
r)C
Feeder
Non -La er
Da' Calf
o Finish
o Wean
o Feeder
Farrow to Finish
FDesign Current
D , P,oultr. aci P,o P.
La ers
a' Heifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[] Yes [ No ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes [] o ❑ NA ❑ NE
❑ Yes VIAO ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

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

FaciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes gNo ❑ 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 YNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes VP
o
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Ej No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes dN o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: /
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (U t4
Date:
2141201

Type of Visit: Q'Co pliance Inspection Q Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 Arrival Time: r Departure Time: County:�-� Region:
218I13�
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �E (sC� G4 WPeul , Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: lgda�
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish b } pp
Farrow to Wean
Design Current
Dai Heifer
D Cow
Farrow to Feeder
Farrow to Finish
Dz, P,oult , Ca aci P,o ,
Layers
Non -Da' ry
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes VN0o
❑Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection: aZ 4 Ian
Waste Collection & Treatment
4.�Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E� No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `to
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 dNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes E6No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes [/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes MNo
❑ 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 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [(No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ENo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
Rectuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes N
IN
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes I
❑ 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 [Z/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 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 Eo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes En
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 131 - MOO, Date of Inspection: h3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �rNo ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes [3/No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 dNo ❑ NA ❑ NE
❑ Yes 2fNo ❑ NA ❑ NE
[—]Yes El"No ❑ NA ❑ NE
❑ Yes dl�o ❑ NA ❑ NE
❑ Yes VNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any -additional recommendations or any -other -comments. -
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C d A�EC.V
Phone: � f(0) ! % � _?,3y _
Date:
21412011

Type of Visit: U7Roi4tine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: b S Arrival Time: Departure Time: County: J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: BE6a!e� �
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number: fflo;L&
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
C+specify Pop.
Wet Poultry
Layer
Design
C►specify
I I
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
I I
Dairy Calf
Feeder to Finish U
d
Da' Heifer
Farrow to Wean
Farrow to Feeder
D t P,ouIt .
Layers
Design
C_a aci_
Current
Rio
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Qther Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 3 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No [3 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? El Yes �T_� ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Noo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: gS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure `I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: c.f4Gc�jV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Zf NV ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta neat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes io
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ❑if4o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L 0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes §0"
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[—]Yes o,
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes � "o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 3 - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes ❑ NA [3NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
IVo ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZN90 0 NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ld N ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any.additional recommendations or any other comments..
.
Use drawings of facility to better explain situations (use additional pages as necessary).
Flo)
Reviewerllnspector Name: G
Phone:
Reviewer/Inspector Signature:
Date: f S
Page 3 of 3
21412011

Facti�ty Number
�..
i� Division of Water.Quality ...
Q Division of Soil and Water Conservation
Type of Visit 6 Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: t / Arrival Time: Departure -Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r- Title: Phone No:
Onsite Representative: FE G'CY CAr^('& Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ ° Longitude: °
Design
Current„ Destgn Current :`ate Design Current
Swiue. _
-'Capacity
Population Poultry' Capacity Population
Cattle --Cap ty Population"...�
„'Wet
can
to Finish
Wean to Feeder
F
❑
❑ ❑ Farrow to Feeder
Feeder to Finish J6nb
arrow to Wean
❑ Farrow to Finish
❑ Gilts
❑ Boars
El La ers
El La ers
El Non -Layers
El Pullets
❑ Turke s
❑ Turkey Poults
Discharges &Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
12/28/04 Continued

'• Facility Number: 31— Date of Inspection t !�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:y4 P&WA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O 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 ENo ❑ 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
Ellt�
7. Do any of the structures need maintenance or improvement? Yes 1allo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E I 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 El Yes �No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LQ ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [I Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EN. ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E]'/No ❑ NA
❑ NE
17. Does the facility lack adequate. acreage for land application?
❑ Yes
„ fNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[/No ❑ NA
❑ NE
Comments {refer to'question #): Explain a4y YES answers and/or any, recommendatio©s ©many other comments3
Use drawingsof facility to better explain situations: (use,additional.pages as necessary): r s
a •.
AL
2y,) C.FICA� CAcr.�/zAt�
Reviewer/Inspector Name Phone: q 76 — 7
Reviewer/Inspector Signature: AMU&Date: Ii
Page 2 of 3 12128104 Continued

Facility Number: — Date of inspection
Re _uired 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. ❑❑ Chn ecklists ❑ ❑ Desi g Maps ❑
p Other
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis' ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E 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?
0Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
6 o
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
L No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L'J No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
EI/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
E I No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L(J No
❑ NA
❑ NE
Additional C6inments and/or Drawings: N. „ - %; mow":
Page 3 of 3 12128104

Type of Visit Co pliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason far Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I rr a 7/ /[J I Arrival Time: _ 7Q�j Departure Time: �� County: AAP& - Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: V`G�tCr 'I' eAMflL�i Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I =61 Longitude: = o = A =
Design C*urrent
Design Current
Design C**urrent
Swine
C►apty Populafion
Population
Wet Poultry Capacity L.
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder
❑Non -La er
ElDai Calf
Feeder to Finish
1660
-)72
❑ DaiEy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
Non -La ers❑
ElNon-Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Farrow to Finish
Gilts
EBoars
Pullets
❑ Turkeys
❑ Beef Brood Cqy'l
Other
❑Turke Poults
❑ Other
Number of Structures:
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L 610EW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 079
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
dNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E4 El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&ado ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ N ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
Lo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Corr ntents`(r'efer to question`#): "Explain any YES answers and/or any recommendations or -any other comments
Use drawings of facility to better -
explain (use addttiottal pages as necessary#:
19,) L�cAt CFRr icaT� o 6v61zfi&E
ReviewerlInspector Name { _] Phone:
Reviewer/Inspector Signature: 4WL919 Date: gbqllo
Page 2 of 3
12128104 Continued

Facility Number: Date of Inspection a
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? E Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other /
21. Does record keeping need improvement? If yes, check the appropriate box below. ElYes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes dJ 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?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9lo
❑ NA
❑ NE
❑ Yes
❑ NA
ElNE
:�No,
ElYesNo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes E o ❑ NA ❑ NE'
❑ Yes
UKo'
❑ NA
❑ NE
El Yes
�o
El NA
El NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes 0No
❑ Yes QNo
❑ NA ❑ NE
[I NA El NE
12128104

Type of Visit TRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit O Complaint O Follow up O Referral O Ernergency 0 Other ❑ Denied Access
Date of Visit: S21 Arrival Time: Departure Time: County: L-11PLIZA-1 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: GEC CArnp[�E,C 1.
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c =1 [= Longitude: = ° =1 = 1{
Design Current Design Current
Swine Capacity Population Wet Poultry C+apacity Population
Design C«urrent
Cattle Capacity Population
❑ Wean to Finish
ID Layer I
ow
❑ Wean to Feeder
❑ Non -Layer I
alf
FK]Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
I00
Dry Poultry
❑ La ers
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
El Beef Stocker
Gilts
❑Nan -La ers
❑Beef Feeder
❑ Pullets
PEIBoars
❑ Beef Brood Co
Other
El Turkeys
Number of Structures:
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
dNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
Zo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

IFaicility Number: 3� — %plq Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Ut?_c1J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
l 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
Zf/No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
dNo
[INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
WNo
❑ 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
Zf/No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
>ZI/No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or l 0 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
Ld N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E.�J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
E3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
lNo
El NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Reviewer/Inspector Name 1Tu 14N � f CM0 0-- I Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Co dnued

i
Facility Number: Date of Inspection z+
R@ uired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[/No
❑ NA
❑ NE
the appropirate box. ❑ VvUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ 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
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Rf No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
7No
❑ 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
5No
❑ 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
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerhnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
E
e of Visit Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
son for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 31 1 Arrival Time: p Departure Time: County: 011LrRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
p
Onsite Representative: ! C, 4&Y 6.gf.,*r C- C, '_
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = O = f = Longitude: ❑ ° = I 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Puults
Other
Cattle
Design Current I
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes o ❑ NA ❑ NE
ElYes No ❑ NA ❑ NE
12128104 Continued

Facility Number: — G Date of Inspection 1i
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LA 6-mN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
t�hr at, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ElNA
[INE
8. Do any of the stuctures lack adequate markers as required by the permit?
Yes
:No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E N
❑ NA
[I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1�No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Q4
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O 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 N
El NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes LJ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes �
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes 7No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ 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):
AL
I
Reviewer/inspector Name 614Phone: 46- 23ft
Reviewer/Inspector Signature: Date: 311 yof
7 VIPR/nd A'--f n..nd

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ff/Nq ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Rio ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes InNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LyNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes No ❑ NA ❑ NE
❑ Yes E�Wo ElNA ElNE
ElYes L3'No ❑ NA ❑ NE
❑ Yes
❑ No
NA
ZI/
❑ NE
❑ Yes
L114o
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
EJ No
❑ NA
❑ NE
NNo
❑ Yes
O
❑ NA
❑ NE
❑ Yes
LQNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104

Facility Number (�
Q Division of Water Quality /
0 Division of Soil and Water Conservation f
0 Other Agency
Type of Visit 0 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �/ /�J� Arrival Time: /Qa 1 Departure Time: County: ! Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: FC-66Y CAS' ?(3 L
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Title: Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e = 6 Longitude: 0 ° = ' 0 «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
1664
/ M
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts '
❑ Boars
Other
❑ Other
Dry Poultry
Non-
Pulle
Turke
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity. Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
QDry 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 L'J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes El No El NA [-I NE
❑ Yes ZET"No [INA ❑ NE
ElYes o ❑ NA ❑ NE
12128104 Continued

Facility Number: -3— t6$ Date of Inspection
�T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes LNo
❑ 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: LA6( AJ
Spillway?:
Designed Freeboard (in): S
Observed Freeboard (in): Z_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes L(J N
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaVth at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [n No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No
El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
Vj No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
I No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name , 10'R lw (� Phone:( % 7 b 7 SO
Reviewer/Inspector Signature: Date:
12128104 Continued

I
Facility Number: Date of Inspection Y d7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ld No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[?Vo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[jio
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[I NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Id NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
CJ No
❑ NA
❑ NE
General Permit? (ieI discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El2 Yes
�/
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q'iVo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

31
Type of Visit ZRo
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit utine O Complaint Q Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: �`� Arrival Time: g S Departure Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �t✓� Y D.
I, Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = 4 = Longitude: = 0 = 6
Design Current
inOCurrent Design
Current
Swine
Capacity Population Wet Poultry
Capacity Population Cattle Capacity
Population
❑ an to Finish
❑ Layer
❑ Dairy Cow
❑ DairyCalf
❑ can to Feeder
-Layet
© Feeder to Finish
❑ Dairy Heifej
6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ La ers
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co l i
❑ Non -La ers
El Pullets
❑ Turke s
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
L N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued
0

1
FacilitV'Number: 31—
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAGD01li
Spillway?:
Designed Freeboard (in):
1 f ..]
Observed Freeboard (in):
31
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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes 2f/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes WNo ❑ 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of Wind Drift ❑ Application Outside of Area
11 Crop type(s) i3 LLi ubA i. �!� 52 0
13. Soil type(s) G A �,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2No
<0 ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes LJ' 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
d l�,/No
❑ NA
❑ NE
ElId 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 Phone: �yV %Y%
Reviewer/Inspector Signature: Date: 1?�
- I- 1-

Facility Number: 3 f — g�p Date of Inspection Z o (o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes EJ4o ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
52 Yes
❑ No
❑ NA
❑ NE
n ElWeekly Freeboard ❑ Waste Analysis ElSoil Analysis
❑ Waste Ap�Zking
ElWaste Transfers
❑ Annual Certification
ElRainfall ❑ 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
ff 1' o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesVNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[d No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ld No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
LJ'NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L' No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
LRNo
❑ 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
2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
VNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�_,/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IQNo
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
O / No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit ORoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 2 Arrivall Time: Z : eparture Time: [� County:
Farm Name: f C.�/r1/� ALL /i��'1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Arla _ _ ir�P G Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Sack -up Certification Number:
Region: W
Location of Farm: Latitude: 0 0 = , ❑ Longitude: ❑ o ❑ i ❑
Design.-. Current' .
Swine Capacity Population
❑ Wean to Finish
, Design Current
WetPoultryV 'Capacity Population
❑ La er
Design Current
_Cattle _ , .*0 Capacity Population
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dai Calf
Feeder to Finish Q
❑ Daia Heifer
El Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
Non-DaiEz
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
r -
❑ Turkeys
Other
❑ Other
❑ Turkey Points
ElOther
Number of Structures:
Discharges & Stream Impacts
1. 1s any discharge observed from any part of the operation? ❑ Yes �No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes s
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
YNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
VNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection Qf
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
�TNo ❑ 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:
^`l
Spillway?: No
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
21 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
0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
JZ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
9fNo ❑ 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
eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ EvidefAinde Drft Application O �'idof Are,
12. Crop tyPe(s)� e ld D 1
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
© No
❑ NA
❑ NE
I5. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J�n No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
Aj
RFi.­tsme(refer, to queshaa #) Ezplarn any YES answers and/or any=recommendat�onstor any other comments.
rawings of facility to bett60e ' lam srtuatrons (ase s ldrhonal pages as�necessary}
2 104V4 1040„1F2 (` Ay :�- X047- ,C_z ,ems -Z
WJ*-�Jf'6-('&40C_rx_.O S AY I20 14red -e 1�Is�cr�notjs� 1 �l
�,� 5 eeoe6_ /D lT ✓f�S r O/Q9i_ �L 4!W 04 � 'L/O6 S f "g7 {�Je[N �r
Reviewer/Inspector Name I I Phone: 3 3
Reviewer/Inspector Signature: Date: Z o
12128104 Continued

Facility Number: Date of Inspection 05
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
)Z No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA ElNE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
'0 No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " 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
[fNo
❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment {PLAT) certification?
❑ Yes
❑ No
NA ❑ NE
Other Issues
10
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'0No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
ZVNo
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
El NA El NE
If yes, contact a regional Air Quality representative immediately
IV
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
P
❑ 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
)z No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA ❑ NE
Additional Comments and/or Drawings:
24) '66 Sam;;O;r
��QA-��G�ua�
y
�/FsSGG-� ��Z�CR-7Z on1S.
12128104

w
-' � � � � � � `IDi�nsxon:of Soil`and Water Conservation
� �: � & �� � �; • Q Qilier Agency `� _ � ..
Type of Visit JV Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: i0 Time: Z�
O Not Operational O Below Threshold
Permitted JfC��ertified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: . .......... ..
Farm Name: ..... f �'' ..... CAr'P 4 tL .._ - - - -- - - -- .......... County:
Phone No:...........
MailingAddress: _..�........................................... - -................
Facility Contact: ............ .............._._ ... ._---------Title: Phone No:
Onsite Representative: ]� �!1 � fie......_.. Integrator: —
_.0 _.................
Certified Operator: . .................. Operator Certification Number: .....................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 9 " Longitude • ' 46
Desrgn
Current s { Designi Cu�i Design Curr ni M
Swrrre Ca aci Po9 vla on Poultry - Ca �ci �:Po ulahnn `,.� Cattle a==aci -Po diction s
❑ Layer ❑Dairy^
-_
: , ❑Non -Layer ❑ Non-Dairy
El
Other' _" F
rToW Design Capaalty
-El
ti
Number of I:agoons
_w
�
,
❑ Wean to Feeder
Feeder to Finish
'$
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )eNo
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 ga.Umin?
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 ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes INo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes INO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ----•--•---... I .................. ...........................--•- ,,..............
Freeboard (inches): 2 3
12112103 Continued

Facility Number: JI — (p$ Date of Inspection 10 O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AR_piication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type E
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?
Odor Lssues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
IS. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
Recoos CAok. G000.
RMM WC[.�L -Rmoc D .
❑ Yes V No
❑ Yes 26 No
❑ Yes [A No
❑ Yes INo
❑ Yes, /No
❑ Yes PfNo
❑ Yes 9fNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes XNo
❑ Yes /No
❑ Yes INO
❑ Yes XNo
❑ Yes INO
❑ Field Copy ❑ Final Notes
��ArJ NA5 (j4APL4 QE,�n�wDA C�+M G2A'LE To , -
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 31 1 Or a1-If
Continued
A"Ai 'Vo

Facility Number: — 8(� Date of .Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 9(No
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 x
�No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes �No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
gNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
XNo
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
'.No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
No
X
31.
e
If selcted, 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 ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

ea
r
Ib-Divr ion of Water Quality
L
O`Diviston of Soil and Water Conservatron
f
Agency
x
w
�,
Type of Visit &Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit a Routine
O Complaint O Follow up O Emergency Notification O Other
❑ Denied Access
Facility Number Date of Visit: 1 bZ Tuner Printed on: 7/21/2000
- - - -- — 0 Not O erational 0 Below Threshold
0 Permitted OCertifiedjj��❑ Conditionally Certified ❑ Registered Date Last Operated or /Above Threshold: .................
Farm Name: t 4-�'rn Sl�'fl.. r�iYist .. County:......Ntt�/&...........................................................
....... _..}. J. / ............p. ....................r.......................
Owner Name I �C4.e1f.lel1,,, Phone No:
Facility Contact:
Title:
MailingAddress:._.._...........................................................................
Onsite Representative: AC✓
Phone No:
Integrator ........ 4'D5...
Certified Operator:.......................................................... ..... Operator Certification Number:..............
Location of Farm:
AL
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �'° Longitude �• �' �"
Design
Current Design Current Design ; Carteot
Capacity
Population.Poultry a ciPoelaon Cattle.
o'-'at. ion
Wean to Feeder
JE1 Layer ❑ Dairy
= Feeder to Finish 160
❑ Non -Layer ❑Non -Dairy
Farrow to Wean
Farrow to Feeder
❑Other
Farrow to Finish
Total Design Capacity
Gilts
Boars
Total SSLVV -
��� ,
❑ Subsurface Drains Present
❑ Lag�x+n Area
Spray Field Area
❑ No Liquid Waste Management System
al� Ponds'/ Solyd Traps
�sF::a..3. .. z ....
,.:
L ,.
Discharges & Stream Impacks
1. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State'' (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier. I
..................... ........ _......... ................ .................................... .................................... ................ _...•--........
000
Freeboard (inches):
S/00
❑ Yes to No
[]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes j$ No
❑ Yes ®.No
Structurc 6
Continued on back

Facility Number- 31 [late of Inspection Z 1f Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �&No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ®.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 M1 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [5No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes MNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes allo
11. Is there evidence of over application? ❑ Excessive PPoonding ❑ PAN ❑ Hydraulic Overload El Yes KNo
12. Crop type l/.:�%llal(!� [ �•( Z W) .�i1lj��.�i�c z5&
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes RNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes VLNo
b) Does the facility need a wettable acre determination? ❑ Yes KNo
c) This facility is pended for a wettable acre determination? ❑ Yes S.No
15.
Does the receiving crop need improvement?
❑ Yes
KNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
CRNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
M 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
Eg.No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
®.No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ffNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
$2-No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
RNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®.No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
lb No
iQ-yiolati6lis:or dfclendieg vt�ere noted -diming this:visit;- Y:oo will-t&6*e Rio further
correspondence. ab' A this visit.
�I-ke � Tte''/jt 1S ice.
PCo.G� fr-t G b D.L it-
) _/�
%11'V3J&, C
qV
Reviewer/Inspector Name
Reviewer/Inspector Signature: ��G - Date: ZAd Z 5/00

• w
Facility Number: 3 - g(y Date of Inspection Z JJ (92 Printed on: 7/21 /2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes '®.No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 51 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes $I 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 EJ 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 19 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 91No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes IgNo
5100

y * iiin idi1 of Water Quality
s �. Divtsbon of Soil and Water Conservation
x' - Other'Agency r Y��
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
t)atc^ of Visit: Tune: �d: 30 Printed on: 7/21/2000
Facility Number (p
Q Not Operational O Below Threshold
® Permitted jZ Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ..................
FarmName: ........ B5.f.6Y..CAMP. UI .......).............................................. Count`°: .......... ave //.............................................
Owner Name:..........f gazai......C,4, e& .............................................................. Phone No: 'Alf 114 1k/......................................
Facility Contact: ............ --4ME.......4;;- Pzj . Title: Phone No:
Mailing Address: J.� OLD / u/'1P!/J ULAY/LL�r /JC;... o7BS tP
I:....$.!...............?.Q.-.....-....................p.....................................Bl...............................�........ .. .............�........
Onsite Representative: .... jO y ,r^i MP r, Integrator: ,., !e4iv� S O� CAAzX-1Al4
..... ...... ........................................................................................
Certified Operator: ............. . . . Operator Certification Number:
Location of Farm:
/IIOQTf/C-f}ST OFtW1A1-Q'/RP/4f-• NOe7W /D6 OG $/Q 19OR #_
lKSwine ❑ Poultry []Cattle ❑ Horse Latitude ©• �` ®°° Longitude I " 1•
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
JE1 Layer
I
Dairy
Feeder to Finish
(0,0O
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
o
❑ Gilts
❑ Boars
Total SSLW
002)
Number of Lagoons O Subsurface Drains Present Laenan Area Spray Field Area
rN
Holding Ponds / Solid Traps I j 1[:] No Liquid Waste Management System .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes E�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance majt-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if dischar-ye is observed. what is the estimated flow in gal/inin"'
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? El Yes ['No
1 Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IM No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: ........312 .................
Freeboard (inches):
5/00 Continued on back

Facility Number: — 8400 Date of Inspection /.2 /�?. 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 R'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 Wo
(If any of questions 4-5 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes j<Vo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes Wo
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 kNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes KNo
12. Crop type &,r*,-L- /Gpy Ze- I— BWAS".-F g44OL-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �rNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes W'No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
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
I7. 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?
Oe/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
}o •061atigris ;oi- deficiencies *ere noted• during this: visit; • Y:ou m ill r" eeeiye do further.
. . - r - -
. • ;corresQndenke abbot}• this visit_ • ...........:... .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes ❑ No
❑ Yes ` No.
❑ Yes XNo
❑ Yes 1'No
❑ Yes KNo
❑ Yes LXNo
❑ Yes *0
❑ Yes b(No
❑ Yes No
❑ Yes No
❑ Yes 5(No
❑ Yes kNo
air, %oars Pnal1 i2y/e !tom es p/ .�.P 6u.� not u/ RS/X h/.s4GP AL
pcir" S4 .t
�.�o rrs �c p •�•� d �.
Reviewer/inspector Name �r J uwQ FZF
Reviewer/Inspector Signature: _ _ J Date: It 5/O0

Facility Number:3/ — �r Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes WO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes W10
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes R1110
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 tWo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Oklqo
32. Do the flush tanks lack a submerged fill pipe or a pei•manent/temporary cover? ❑ Yes ❑ No
5100

[3 Division of Soil and Water.Conservatioct ._operation Review
%0 Division of Soil and Water Conservation Compliance Inspection
10 a.
Division of Water Quality Compliance Inspection
-
Other Agency _- Operatiaii Review
_
(XRoutine Q Complaint Q hollow -up of DWQ inspection Q Follow-up of DSWC review Q Other f
Facility Number Date of Inspection (►
Time of Inspection I S`�-LuJ 24hr. (hh:mm)
© Permitted ACertified © Conditionally Certified [a Registered [] Not Operational 1 Date Last Operated: P ..........................
Farm Name: �.C.F- ........ ....._.......J.— Yvl County:..C..nl..{.L..G�..........................
Owner Name:..;�i.�r�c- .................. fY1 n�.G�.�3.. .L. L ................ Phone No: �...R....Z.......-f.� �..1..............
Facility Contact: .. Title: ............................. Phone No:
Mailing Address: ... 1.5i�.�.......Q.t.—D...... �.1 i.I.Cl.t .L1 .ni.. ..... -57. .�3�L.1i.Tz4.\/..L.LL .1...--vvc......... .1. ..
Onsite Representative. Y....... CL3..�.f..integrator.
.................!
..._.................................
Certified Operator:,P'jr` Operator Certification Number:
Location of Farm:
ETD,0`.k ...�.I-A...OQ AVM .I.n..r.....T^ 1 .............. ......S.l ....] t' .......' .-Q.�.t"1................
h.T..._Q..t`1......5.hs..17....T...h-EA`I. .I—.... .t. :S... "..L.L.. ... . ..._ t -. ...................
t��,
Latitude �' �' Longitude ©� ®° " G-a O a '1�n 6 Ot—� p t t ��" ►a,0
- _ Design Current T Design Currenth ta�Lt.� pesin Current
Number pf.l.agogiis Subsurface Drains Present 1111 Lagoon Area Spray Field Area
HoldingPoids / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream I pacts_
1. Is any discharge observed from any part of the operation? [:]Yes JKNa
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If diseliarge is observed, was the convevance man-made? ❑Yes B�No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Wo
c. If discharge is observed, what is the estimated flow in gal/min'? !V\ / A�
d. Dees discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes KNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ®'�T0
Waste Collection & Treatment \
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 - Structure 4 Structure, 5 Structure 6
Identifier:
Freeboard(inches). u................................... ................................ ..... ................................... .........................................-_...........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.) l
3/23/99 Continued on back

Facility.Number: , ( - Date of Inspection 1 �,
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El 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 )<No
$. Does any part of the waste management system other than waste structures require maintenatce/improvement? ❑ Yes KNo
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 *0
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes )<No
12. Crop type C_QA S`r-,,k I__ 1;S J_ZU-1AA ( 1 t) 1 s�Y� OL1
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
Wo
c) This facility is pended for a wettable acre determination?
❑ Yes
KNo
15. Does the receiving crop need improvement?
❑ Yes
91No
16. Is there a lack of adequate waste application equipment?
❑ Yes
I-10
Required Records & Documents
IT 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?
N6-yi61ati6ris:or deficiencies •v�er'p noted d&ihi! this.'visit: Y;oi) Wfl-Teceiye lid further
corres�ondeizce abaiak this .visit. _ . . • .. . .
lc—O
mments°(refer tosgtxesh6n #) Explatn'any YES ans±gvers atdlor aany recommendations oi=:any other comments
Use°drawtngs of facility to_5etter_expiatn sttuahons (use addtifional-pages as necessary)
do .
4, 'VLk s L P.-LAA- C, B r�t� t� t t_ c� c, S r4c_,AAA_ h O
❑ Yes gNo
❑ Yes gNo
❑ Yes �kTNo
❑ Yes No
❑ Yes o
❑ Yes $(No
❑ Yes fQTNo
❑ Yes KrNo
❑ Yes �To
w —
Reviewer/Ins ector Name
p
Reviewer/Inspector Signature:,t ��J �{ Date: t --I_ , - , q c7j
3/23199

Facility Numher:3 — Date of Inspection
Odor Issues
26..Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes PR�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 gNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
. roads, building structure, and/or public property)
29_ Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes U�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 RNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes VNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [:]No
Additional Coinihentsan _or awingss,
AL
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
13 Division of Water Quality
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection T�
S
Time of Inspection 6 24 hr. (hh:mm)
D Registered 99 Certified 0 Applied for Permit 13Permitted 10 Not Operational Date Last Operated:
Farm Name: Count .. .......... ........ I..............
.............p'51........�.� - L .................................................. y......Du¢I� ...
Owner Name:..................P 3-1
-.........................C44
ell......................................... Phone No:.....�.`rlQ ..Z � �i.............. I..........................
FacilityContact: ............................................................................... Title:................................................................ Phone No:...................................................
Mailing Address :......... !.jj....... ()U.......
CLn.q. wt u ........�,............................
l�ui�� 4
�.................................... ... � ��........
Onsite Representative: ..................
ii
..... C&4,pbjj..............................................
Integrator:.......,li'fV4+ilr%4.......................
y�
Certified Operator;................................................................................................... . Operator Certification Number-,
Location of Farm:
...0sas... k" ail.s......MK...........P.:�'......MW-4 4.................................................................................
...... ............. I ................................. ..........................................................................I....................... IF
Latitude [::�•4046 Longitude 0• A "
]3es1gn : Current Design
„ _ _..
'Capacity
Current:. �,.Desigtt ..; Current
Capacrty`:Population
Poultiy
Population Cattle,_ Capiki Po ulatton
❑ Wean to Feeder
❑ Layer
❑ Dairy
® Feeder to Finish (pCo
10 Non -Layer 1
1[:] Non -Dairy
❑ Farrow to Wean
;
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
a
Total SSLW
¢
Number of Lagoons 1 Holdrng Punds
Subsurface Drains
Present
CI Lagoon Area pray Field Area
❑ Rio Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes P 'No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ 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/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes EP 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 [P No
5. Does any part of the waste management system (other than lagoons/bolding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ( No
7/25/97

Facility Number: > —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (LaeoonsMoldine Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): ............ .- ................. ..........
10. is seepage observed from any of the structures? ❑ Yes P No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 19 No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
® No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
[2 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15.
Crop type .......... . . ................... 1..............................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
93 No
IT
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
S� Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
I'No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[A No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Onl}
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
RNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
( No
0• No.vialationsor deficiencies. were-noted-durmg' this: visit:- You'WiU �ece_ive' ,16 irihei- .'
eorrespkidence about IEhis:visit.- :::::. :: ::. :::. ::::" :::
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5V.I MC
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S?vm- puti w �w�t�� kn
7/25/97
Reviewer/Inspector Name>
Reviewer/Inspector Signature:
Date:

��----
❑ Dtvtston of Soil and Water Conservation ❑Other Agency T
Fill MF
Dtviston of Water QuaLty ��
9 Routine O Complaint O Follow-up of DW2 inspection. O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection tm 24 hr. (hh:mm)
© Registered ® Certified © Applied for Permit [3 Permitted JE3 Not O erational Date Last Operated:..........................
Farm Name: ...... .F;a County '�...�.s .,n................................ t...
Lo
Owner Name:............. ......... ................................... Phone No: ... (.A..1.4.)... ......................
Facility Contact: ............................................................. ..... Title: ...... Phone No:
.........................................................................................................................
Mailing Address: �.r�.�'..L.......Q..Ld....�,Lyi.,,�. c , a. ... ..................UQ_. ..:........... 2.�.. �... ..
Onsite Representative:....pq..........4.ru..p.!� t,.�.�.. .... Integrator:... �aira,,r�.ux................................................
CertifiedOperator:............................................................................................................... Operator Certification Number:........................................
Location of Farm:
I...,yr•srw....�..r- ......w•..-...d..� ..y.. ..t.. ..1.. ...... __... ...r.. _. .......... ... ........ ........ ..7 1
Latitude Longitude ' 0' "
g
Desigd- _Current _;'' Design £urrent Design* Current
Capacity.; Population Poultry „ a KCapacity. Population - Cattle , „w Capacaty Piipulahon
❑ Wean to Feeder ❑Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean h "
El Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity.,
❑ Gilts: -�;
❑ Boars °Tota1SSLW "
Numb&.6f 11 goons! Holding Ponds S*ubsurface Drains Present Lagoon Area Spray Field Area
...... ........ ......... -
10 Liquid Waste Management System _
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 gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not incompliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 19 No
❑ Yes 10 No
❑ Yes E9 No
❑ Yes ® No
❑ Yes ® No
❑ Yes 91 No
❑ Yes ;0 No
® Yes ❑ No
❑ Yes t9 No
❑ Yes l$ No
Continued on back

Facility Number: j —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lagoons,Hald,ing Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes JjLNo
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
........................................................................................................................
Freeboard(ft): ................................. .... ...... ............................. .............. ...................... .............. ..................... ............................
10. Is seepage observed from any of the structures? ❑ Yes ENO
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?
NVaste 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 b.tr .. r... `.�m..f....................................................... ... I-_.�............._..........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
®' No.violations-or defictencies.were noted -during this;visit. You'will receive•no-ftirtlier . -
correspondence ai out-this'visit:
❑ Yes RNo
❑ Yes 19 No
❑ Yes IR No
❑ Yes MNo
❑ Yes KNo
❑ Yes RNo
K,Yes ❑ No
❑ Yes j$ No
❑ Yes ®,No
❑ Yes KNo
❑ Yes J$ No
❑ Yes Wo
❑ Yes KNo
❑ Yes (LNo
Gnmun is {ref£ er to questEon #) - Explain any YES ansWV s arid#or any rreanmme ttons o any ottheec mmen ':.
Use drawtngsfof facthty to better axpiat r sttuatioms (use additronal pages as�necessary) gkm
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Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
Le— I