310871_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua!

Type of Visit: j2rCoinpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: _0 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
- r.�nrrri w
Date of Visit: p�� Arrival Time: Departure Time: ® County: �� ir't Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: 19 3 4S
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Desigu
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Da Calf
Wean to Feeder
Non -Layer
Feeder to Finish
�jD
D , P,uul_ ,
Design
Ga acit
Current
P.o ,
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non-Dai
Farrow to Finish
Layers
Non -La ers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Pouits
0ther
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 J;R'No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

IFacUity Number: -921 71 Date of Inspection:
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: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J�
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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �© _ _o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes ''1lo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes�o ❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops direr from those designated in the CAWMP? ❑ Yes ja<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes,,la"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes .10 [;�to ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes J;a'No ❑ NA ❑ NE
❑Yes ❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes j2rlhfo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes _E],No ❑ NA ❑ NE
the appropriate box,
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes_,Ej"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONO
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

j Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes FeKo ❑ 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"P"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �'IC1A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes,,L2-1,�o
❑ NA
❑ NE
❑ Yes 'Ca'<o
❑ NA
❑ NE
❑ Yes 1 o
❑ NA
❑ NE
❑ Yes ONo
❑ NA
0 NE
❑ Yes io
❑ Yes�No
❑ Yes IE511�0
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #):' Explain any YES answers'and76r 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 Signatui
Page 3 of 3
Phone: I 1 H"l ` 1'5d
Date: 'YtC
21412015

Type of Visit: Qr7Routine
pliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Lo 'S Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone:
Integrator: �/
Certification Number: I? S i
Certification Number:
Latitude: Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
EFEINon-L]ayer
"ea I r'nJELCurrent
Wet Poultry C►apacity Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Dai Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
O3
ent
C•_a aci. P,o P.
Layers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
jrb7,
Beef Feeder
Boars
Beef Brood Cow
Other
Dischar es and Stream Im acts
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 io
NA ❑ NE
Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
44. 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 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
l�L1L
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
[3/No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment
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
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
VNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes hio ❑ NA ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Q No
❑ 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 ��No
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes d,11 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes o
❑ NA
[] NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes WNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NF
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspecti;<N'
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes No❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection:
z4. 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 ZNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[:2/No
❑ NA
❑ NE
❑ Yes
EA No
❑ NA
❑ NE
[:]Yes
E�/No
❑ NA
0 NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
ZZo ❑NA ❑NE
o ❑ NA ❑ NE
No ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Usedrawings of facility to better :explain situa.t.i.ons (use additional pages as necessar
y)—,
PAD
Reviewer/Inspector Name:
P, A Vo 0— C A9_, I -6 t
Reviewer/Inspector Signature:
Page 3 of 3
Phone(
Date: l0
MfRIM

Type of Visit: 0 Ctoutine
lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
isit: Reason for VO Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:,J�f,Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1 Title: Phone:
Onsite Representative: gtW1A co 6 � Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design C►urrent
C►at#le Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
feeder to Finish
Q06
;i%
Design Current
Di, P,oul C•_a sci P,v ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
arrow to Wean
Farrow to Feeder
Farrow to Finish
p
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and 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 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 rl�o
❑ Yes
[3 Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: jDate of Inspection:
Was a 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
,,Sttructure 1 Structure 2
U,
3C
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 16 No ❑ NA ❑ NE
❑ Yes ZNco ❑ NA ❑ NE
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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ErNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
WNco
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ 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
❑ NA
❑ NE
acres determination?
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 rNo
❑ NA
❑ NE
Required Records & Documents
�NA
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 1" o
g
❑ 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 [DNA ❑ 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 h ,,No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

lFacility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
,14
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below,
❑ Failure to complete annual sludge survey Cl 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:
❑ NA ❑ NE
No ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ZIC
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
0 Yes
121/No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
/No
❑ Yes
0
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
l__I 1V ❑ NA ❑ NE
[. ❑ NA ❑ NE
o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.,
Use drawings offacility to better explain situations fuse additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C l Phone — 3 (J d
Date: Ip S
h ,
2/4/2 l S

t,
Facility Number - 111 Division EO'Soi E and Water Conservation
� Other Agency
Type of Visit: C pfiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: g Departure Time: County: Region:
Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CV tr fiCfZ _ ? A(ZEF'our
Phone:
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
1?3�S
Design C►urrent
Swine Capacity Pap.
Wean to Finish I
Design Current Design Current
Wet Poultry Capacity Pop. C►attle Capacity Pop.
jLayeT Dairy Cow
)t
Wean to Feeder 966 —0
INon-Layer_l
Dairy Calf
Feeder to Finish ODD
Dairy Heifer
Design Current Caw
D . P,oul_ -a aci P,q Non-Dai
I Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes a No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ YesgNo
No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: (o
r Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure`I Structure 2 Structure 3 Structure 4
Identifier: U� iso 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �J3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑NA ❑NE
Structure 5 Structure 6
�Ycs j No
❑ Yes n No
❑ NA ❑ NE
❑NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E7 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?
WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ 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
FfNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0lea
❑ 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
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
YNo
❑ 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
[ErNo
❑ 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
0o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 151-911Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ;3'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
ornments (refer to question #): Explain any YES. answers and/or any addi
se drawines of facility to better explain situations (use additional pages as
Na iT JLx woo -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes CZ"No
❑ Yes E No
❑ Yes M/No
❑ Yes [n No
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [✓� o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
ons or any other comments.
Phone: (Rib)
Date:
21412011

Type of Visit: U Co pliance Inspection O Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: 7Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �,( j Arrival Time: ® Departure Time: ® County: l T Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Sm?eQ,� L 1u uufl-,� Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
I?34's' -
Swine
Wean to Finish
Deslgn
Capacity
Current
Pop.
Wet Poultry
Layer
Deslgn
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
1
jNon-Layer I
Dairy Calf
Feeder to Finish
}( Farrow to Wean
Farrow to Feeder
Farrow to Finish
4 Q
ZUX>
DrY P,oult .
La ers
Design
Ca aci_
C*urrent
P,o ,
Dairy Heifer
Dry Cow
on -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar es 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 dNNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes Zo ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

[FacUity Number: jDate of Inspection: S OW Is
Waste Collection & Treatment /
4. 1 ,storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2
Identifier: LAc7m
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
3n
❑ Yes IzNo ❑ NA ❑ NE
❑ Yes ]6No [DNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Structure 3 Structure 4 Structure 5 Structure 6
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en ronme I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [f No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes [Z(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EI�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes FglNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [�
❑ Yes [�No
❑NA ❑NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes C3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ea/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 C30ONo ❑ 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 10 i10 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [yNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection: -14 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
�o
R
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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:
❑ NA NE
❑ NA NE
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 [No ❑ NA D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[-]Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[-]Yes
E2/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
C2(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
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[] Yes
[
zo
[] NA
D NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ 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)..' _
q) So ran, E 1T �L C LOA L.L— &aA,55 C.N E.(-Z-_ W O F_�_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone(. 10)
Date: F2-1
4/Z 1

Type of Visit: (ZCo�ipliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other O Denied Access ""i
Date of Visit: Arrival Time: ® Departure Time: EUP-71 County:J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: FvE P :qy r, ��► G j` Integrator:
Certified Operator: Certification Number: 12 Nt
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design C►urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
O
1 INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Q
U pa
Design Current
DaiU Heifer
Dry Cow
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Turke s
Other Turkey Pouits
Other Other
Discharges and Stream Impacts
/wo
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ 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: LA C'ac� 0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2�
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 21 No ❑ NA FINE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or7Yesnmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ®No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:)Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
01,410
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
04o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Vo
[3NA
❑ NE
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F1<016.
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;�Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a"No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:],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
014110
❑ 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
[3"No
❑ 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
21417011 Continued

FaciliNumber: Date of Inspection:
24. Did the facility fail to calibrate was a application equipment as required by the permit' ❑ Yes o ❑ NA ❑ NE
1G. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: ,
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q"o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
[—]Yes dNo ❑ NA ❑ NE
❑ Yes [. Np ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
Comments (refer to question f: 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
R 0 (_- Ck_,
Phone: t ID
Date: S L
/4,1201

Di
Facility Number; g'j ODD
O�o
.�
ision of Water Quality
Won of Soil and Water Conservation.
ier Agency =
Type of Visit Co fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r1 d3 Arrival Time: Departure Time: County: DUPb',10 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: T K) Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I Longitude: [= ° 0 .
Desi n� Currenf`
g Desrgn Current .� :. _ Design�Curren#
Swine Capacrty Population, "Wet Poultry 'Csp �i�y . Populatto-n Cattle "r--Capacity Population
__ ...
❑ Wean to Finish r ❑ DairyCow
Wean to Feeder gco Q �~~❑ La e❑ Non -Layer ❑ Dairy Calf
Feeder to Finish jj�} '] - , 4: ❑ Dai Heifer
Farrow to Wean `y El Dry Cow
-Dry Popltry
�r ❑ Farrow to Feeder ❑ Non -Dairy
ElFarrow to Finish :, El Layers ❑ Beef Stocker
❑ Gilts
El Boars
Non -Layers ❑ Beef Feeder
Boars ' El Pullets
- ❑ El Beef Brood Cow
Turke s
Other ❑ Turkey Pouets ," Y
ther _ ❑ Other
tuber: Structures ;4
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? {If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
❑ o
El Yes
L✓J No
❑ NA
❑ NE
❑ Yes El No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: `31 — $ f Date of Inspection DtWo
Waste Collection & Treatment
4. I5 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: l�1_07W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y b
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes - �No ❑ NA ❑ NE
❑ Yes 2/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Flo ❑ NA El 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 L 3tvo ❑ NA ❑ NE
maintenance or improvement?
Waste Aaolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J� 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 Ibs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LdNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[2/No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
L�
[3 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�rNo
❑ NA
❑ NE
Comnnents'(refer to questioq°#): 'Explain any'YES answers and/or any recommendanons or,any otheucomments r
w
Use drawings of facility to better explain -situations (use additional pages as necessary) Y
ESC {Jb CI NC,-6� To �'►Ici~1_. —(T, d 6 cd W LAe 06 iA. &at^" E PL*^ P*J G- G � rkS C iJ
VVLLL LE `f

Facility Number: Date of Inspection �3
Rewired 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 WNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [(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? ElYes Ld No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L_1 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?
Other Issues
❑ Yes
[:] No
❑ NA
❑ NE
❑ Yes
(o
❑ NA
❑ NE
El Yes
WNo
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
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
No
[INA
❑ NE
ElYes
,C
LI No
❑ NA
❑ NE
❑ Yes
[No
❑ NA
❑ NE
❑ Yes
LJ No
❑ NA
❑ NE
❑ Yes
L/J No
❑ NA
❑ NE
❑ Yes
UR NNo
❑ NA
❑ NE
I2,128104

1
L
f Visit Q Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
n for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �3 Xrrival Time: e%i eparture Time: County: ' Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:yl n i r�- S6j11
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No.
Integrator: Zf
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = ❑ « Longitude: = ° = =
Design Current
Design Current
Design Current
Swine Capacity .P.opulation
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
1
❑ Layers
❑ Non -Layers
ElNon-Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
qNo
❑ 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
Z No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P-No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[:]Yes
V No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

f
Facility Number: — g711 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ff No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ;2Vo
❑ NA ❑ NE
Stru ture 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
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes FZrNo
❑ 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 [rNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes Po
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. -Does any part of the waste management system other than the waste structures require
❑ Yes �3Vo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes VNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes (P No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[;&
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes,{
No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
ICJ o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
JJ No
❑ NA
❑ NE
-
Comments' refer to uestion # : Explain any YES answers and/or any cecommendatio of n­,other comments.
Use_drawin s.offacilit5to: better ex lain-situations:(u.se:addtttonal a es as necessat'Y)
-
Reviewer/inspector Name _� " ' ' �; � Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: '3 [ — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EfNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ?No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;'No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ 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
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Z—No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
"No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
YJ 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
2No
❑ 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
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
101.7 A 7
12/2&04

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit la Routine 0 Complaint 0 Follow up 0 Referral () Emergency 0 Other ❑ Denied Access
Date of Visit: 3 / Q Arrival Time: ,= (/Ji% Departure Time: County: Region:
Farm Name: r r �� ��G//l7 ` _� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone. No:
Integrator: %/![(VD
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 ❑ Longitude: = ° ❑ 1
Design Current
Design
Current Design Current
Swine Capacity Population
Wet Poultry
Capacity
Population C+attle Capacity Population
❑ Wean to Finish
Layer
❑Dai Cow
I Wean to Feeder _5 o G .5'U
Lo
L❑
❑ Non -Layer
❑ Dai Calf 1
FE3, eeder to Finish (� 60G / O
0 Daia Heifer
LZ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non-Daiix
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
Non -La ers
Beef Feeder
❑ Beef Broad Co
❑ Pullets
PO Boars
❑ Turkeys
Outer
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [2No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[TNo
[]NA
❑ NE
❑ Yes
[fNo
❑ NA
❑ NE
12128104 Continued

)Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J:�IQo ❑ 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 PNo ❑ 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 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ No El NA El 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 Jallo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PrNo ❑ NA ❑ NE
maintenance/improvement?
11
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;21<0
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soi:
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area N
12. Crop type(s)
13. Soil type(s)
El NA ❑NE
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 /EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes EfNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;21�o
❑ 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: y 7V6
Reviewer/Inspector Signature: L /� Date: J �(0 66
Page 2 of 121 8104 Continued

V.
Facility Number: — Date of Inspection Q
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
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
/ZNo
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 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?
[:]Yes ,EfNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? ❑ Yes ONo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes P No
r
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes UNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 2No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 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 ['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 ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes A!�No
❑ 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
Page 3 of 3 12128104

L
fVisit eCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit.Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 4 aS os Arriva ime: •`(1 d Departure Time: County: it --Region: w
,. J .r
Farm Name:
Owner Name:
Owner Email:
_ Phone:
Mailing Address: *9bj
Physical Address: +
Facility Contact: �d i Phone No:
Onsite Representative: 1 t/'ntegrator: Y
Certified Operator: �- - -- -r Operator Certification umber:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [=e ❑ ` ❑" Longitude: ❑° ❑, 0 i,
Swine
❑ Wean to Finish
OW'ean to Feeder
ET -Feeder to Finish
1715-0
Farrow to Wean
0
3 S
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et I EEEI
Other
❑ Other I_ .....
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
iryHeifej
❑ Dai
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 LR'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
DNA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
j'No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 $ ? Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ONo ❑ 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): � 5'
Observed Freeboard (in): Gj
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes -fNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ONo ❑ 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 Lallo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
gNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
�2'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Z 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of WindDrift El Application Outside of Area
12. Crop type(s) ��1' L�� ri(/
Owl 1.5
i.l r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
ffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
EfNo
❑ NA
❑ NE
17. Does the facility lacy adequate acreage for land application? ❑ Yes
ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[;I*o
❑ NA
❑ NE
A/;- I -S 114 ✓
ACecoj-ors n� V°-ar
r`�
Reviewer/inspector Name ! K. Phone:
Reviewer/Inspector Signature: Date: l0 7 G
12128104 Continued

FacilityyNumber:3 1 —9 7
ADate of Inspection
J
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes eErNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EI No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
.'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;3No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;2"No
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
01Io
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J�jNo
❑ 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
El 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
ONo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J I1 o
❑ NA
❑ NE
Additional Comments and/or'Drawiugsi
12128104

of Visit
Reason for Visit
Inspection O Operation Review O Lagoon Evaluation
O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
acility N er Date of Visit:
Permitted Certifield {13 Conditionally Certified [3 Registered
Farm Name: ... ! Tt...••'••� �T�f. l..... r � .. .L.�.......................
LU67qTime:
10 Not Ooerationai O Below Threshold
Date Last Operated or Above
jThreshold: .........................
County:.......... 0LtrL. .......................— .... _ ..........
OwnerName: .... ................................. .. .....Phone No:
Mailing Address:.. , ..... ... .._. �_..
FacilityContact: ................................. ............ ....................... Title: ................................................... Phone No:
Onsite Representative:..... � .! 1. � tMS N.............................. Integrator:......... 9074 J........ ........... ............... ...... .............
Certified Operator: ..._...._._.... W....... .. Operator Certification Number ............... .. _.......
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude • 4 " Longitude • 4 49
Discharges & Stream Imrsacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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 gallmin?
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
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
[fNo
❑ Yes
WNo
❑ Yes
ellNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......... I ..... ......... _... _.... ...... ............T_..._.-
Freeboard (inches):
12112103 Continued

Facility Number: — 7 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
[Z/No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
ZXO
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
N
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VXo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 1 jc g-mvo A 6, (; Cx 0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EX
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes N/
15. Does the receiving crop need improvement? ❑ Yes [2'No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. 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? /
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes rNo,
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or,public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes
Air Quality representative immediately.
Comments (refer t4 giueshan,#} F.7tplatn any4YES,;agrswers stnd/or4ny recammenelstions yr any athez oommtnts. x �
Use drawrngs oiiar #y�to better explan� situat qar-(ase,'additional pages as necessary) Field COPY ❑Final Notes
m. — f r
E. ^e, ;.q-.:.. -^Z' �.: �� .,®;.......-��,x��'°`"-�-ra�,�v_......-. ,—m--.. ��"�._=:.�"i b�.:i:,wa--�r'i;saY...,»`,.::;._'��—e�.r_''.^.:... m�a..•...,.._am.. �'�=r .�r;x-
�ZE co 4-
All
j etos�lrt—
T
Reviewer/Inspector NameAL
Reviewer/Inspector Signature:Aa,12Date: &/ax!)
12112103 1 1 Continued

Facility Number: 31 —1911 Date of Inspection I &ITI-10-1
!
Renuired Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NIPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes EJ No
❑ Yes E�<
❑ Yes L:I No
❑ Yes EVo
❑ Yes 0 No
❑ Yes /No
❑ Yes Q N
❑ Yes
❑ Yes No
Yes ❑ No
❑ Yes
❑ Yes rNo
❑ Yes [340
❑ Yes
❑ Yes No
12112103

Date o1'visit: Time:
Facility Number
10 Not Operational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated or Bove Threshold:
Farm Name: ZZ,P i �iG �"ir14 �lh e- County: AA &6 ley
.01
Owner Name: ✓ �7Bn l� `G�1 Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
JJ
Onsite Representative: �LJ/�f'� Integrator: !rY h
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude 00 0 0 " Longitude 00 0"
Designetrrent A .. Design-__: , Current :Design. Current:
Swine aci_:Pouty Population CaseitrPatlaa lcn
❑ Wean to Feeder= ❑ La er ❑ Dairy
❑ Feeder to Finish Non -Layer 1;
❑Non -Dairy
® Farrow to Wean -
❑ Farrow to Feeder ❑ Other _
❑ Farrow to Finish 'Total Design Capacity
❑ Gilts
❑BoarsTota1SLW
Number of Lagoons ❑ Subsurface Drains Present ❑ L oon Area ❑ Spray Field Area
Holdin Pt►uds /Solid 3 ra s`Liquidi ~
g p �` ❑ No Waste System y v'
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ LaQoon ❑ 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): �l
05103101
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes KNo
Structure 6
Continued

Facility Number: E —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes j"Nj No
❑ Yes ® No
❑ Yes] No
❑ Yes No
❑ Yes U.No
Waste Application
rvr
10, Are there any buffers that need maintenance/improvement? ❑ Yes UY No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload/ ❑ Yes EN No
12. Crop type yl ze C<l .� r4 '7�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes DTNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
91 No
16.
is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P9 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
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
59No
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
M No
�j No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) Explain any YES answers and/or any remmmendations or any ut_her`comments.
0-
itse drawings of fact7ity to better explaui sitiradons' fuse additional pages as necessary) ❑Field Conv
n ❑Final Notes^
�. _.
Reviewerlluspector Name
Reviewer/Inspector Signature: Date: r �Z
05103101 ` 6)
Continued

Facility Number: Date of Inspection
Odor. Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below ❑ Yes 93 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes R N°o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZI 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 OJ-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 U-No
3 I . Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0140
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes [&No
Additional'Comments.andlorDrawvings:.
O5103101

� � � n �. -�� x t", Division of Soil slid Watetr Oonservattott � a � -�
Type of Visit XCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit l6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: S 1 Time: 0 -
31
Q Not O erational Q Below Threshold
,#Permitted 13 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ...............
County:...V...r` •................................ ....................... Name: ........................................................ i :............................
OwnerName: �� �1+..`......a v!'L..!Z.tr..:......................... Phone No:...........---.........................................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative:... S-1 efO_r...Q�..�1 ........G!�.. Q Integrator- r r1.:...............................
. ..... ]
Certified Operator:............................................................................... .......... Operator Certification Number:
Location'of Farm:
AL
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• ��°j Longitude �• �� ���
Design Current 'Design
Current Desi T G�
C'rccnt
Swine aostri Panufation Poultry -Ca aci' Po elation Cattle Ca Ci 'Po ela n '=
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other _ -
ToW Design -Capacity
T©W. SSLW -.
Number of Lagoons. 1 10 Subsurface Drains Present ❑ Lagoon Area JEJ Spray Field Area
e,
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made9
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 ................... .................................... ................................... ...... .............................. ........... ..................
Freeboard (inches): , 25
5100
❑ Yes gNo
❑ Yes A No
❑ Yes �'hT0
❑ Yes
9 No
❑ Yes
IR No
❑ Yes
P1 No
�t
❑ Yes
Ja No =�
Structure b
Continued on back

Facility Number: 31 —691 Date of Inspection IT.�/ 01 I Printed can: 7/21/2000
'S.' Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes F4�0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes XNO
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ff No
11. Is there evidence of over application? ❑ Excessive/Ponding ❑ PAN ❑ Hydraulic Overload
El Yes O'No
12. Crop type 13e nn vGt! Gv� ze, r It C� ,r r, O'n be A n f
13. Do the receiving crops differ with those designated in the Certified Anima Waste Management Plan (CAWMP)?
❑ Yes E(No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ,16 No
b) Does the facility need a wettable acre determination?
❑ Yes ONo
c) This facility is pended for a wettable acre determination?
❑ Yes fNo
15. Does the receiving crop need improvement?
❑ Yes PNo
16. Is there a lack of adequate waste application equipment?
❑ Yes /ZNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes E No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes �TNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 0No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes j2rNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes )'No
(ie/ problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes PNo
24. Does facility require a follow-up visit by same agency?
❑ Yes J6 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 1P No
.. . . yiolaiiQr. . ... .. n. . �........... g �his:v......will ... . e ti f. . .
cor'responcience. about this visit. •
nments (refer to question'#): Explain any YES anawers'at
drawings_of facility to better explain situations. (use addil
>cC'; (" f L7 cjmd rez a v-d s, r-,,- c w el l
d/or any ireconimendations or any other comme
ional pages as necessary)
kelol,
I&
Reviewer/Inspector Name
Reviewer/Inspector Signature: j _ Date: �y S $ 5/00

Facility Number: — 9f]1 Date of Imrspection y
,.Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ElYes NNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0 No
2$. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JS 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 fid 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 V.No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 8 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Ndditional Comments_and or Drare ngs:.
a
7

Facility Number Date of Visit: (L Time: ;Q Printed on. 7/21/2000
Q Not O erational Q Below Threshold
Permitted � Certified ❑ Conditionally Certified 0 Registered Date Last Operat d or Above Threshold:
Farm Name: 'Y 7 w .'�Y �T �dM if V1✓ .. lC�. .- County:........ .............................
Owner Name:. .....t. !k........... c.... x � - '-YJI`�6V ..................... Phone No: ..�......... V..... ... Z.��. ..........................
Facility Contact: 61tf . �.......1." 1 � 10�wt,SQY� itle:............[1. ....... Phone No:...................................................
MailingAddress:.......................................................................`.................. .............................................................................................................. ........................
Onsite Representative:........`. Ja- Integrator: ...........................................................
r
.................. .. ......... ................. ..
Certified Operator:,,,,,.,,, . �W —6perator Certification Number: ..........................................
........ .............._�............. 5..........
Location'of Farm:
OtQwlne ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �«
Desi� Current ' Design Current Design Current
Polty CaciPoelaon CattlePopulation - Population
^ can to Feeder ❑ Layer FP Dairy
Feeder to Finish QQ Q ❑ Non -Layer ❑Non -Dairy
Farrow to Wean Q
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
Boars TotaiS,SLW
Nair of Lagoons m ❑ Subsurface Drains Present ❑ Lagr+nn Area ❑ Spray Field Area
--#4dmg Ponds l Solid Traps,.1 ❑ No Liquid Waste Management System
DischaMM & Stream Impacks
1. Is any discharge observed from any part of the operation? ❑ Yes %,No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. li' discharge is observed, what is the estimated flow in gallmin? r
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 WNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 11To
Waste Collection & Treatment \
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier: !/
37 ............. ...... ......................... .... . ... I ......................... .............................
Freeboard (inches):
5100
❑ Yes ['KNo
Structure S Structure b
Continued on back

Facility Number:: ,— Date of Inspection ( Da Printed on- 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obsery d? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
qNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
*0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
J
elevation markings?
❑ Yes
9No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
11. Is there evidence of over pplication? ❑ Excessive Pondi ❑ PAN [I Hydraulic Overload
❑ Yes
ONO
12. Crop type J
13. Do the receiving crops differ with those es�gnated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
,rNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
klo
b) Does the facility need a wettable acre determination?
❑ Yes
CK-No
c) This facility is pended for a wettable acre determination?
❑ Yes
Flo
15. Does the receiving crop need improvement?
❑ Yes
[ATo
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
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 XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes KNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes XNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 6No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes Wo
23. Did Reviewer/]nspector fail to discuss reviewlinspection with on -site representative? ❑ Yes JXNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 5rNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes W-No
Q violatiQtis:or• di fcienci" -mere noted- during this:vlsit: - Yoit will-teceiye irio Further ,
• oorresporidenee: about; this .visit.
Comments {refer to question #) Explain any YES answers and/or any recommendations or:hny other convnernts
Use::drawinigs of facility,to better explain situaticins: (use additional pages as necessary) --
.�•tl/a)a0
&VI0, i
_7 - �: >
�.
Reviewer/InspectorNamezz jdr Zj
-
Reviewer/Inspector Signature:(::;;7 Date:

Facility Number: — Date of Inspection 3 Printed on: 7/21/2000
Odor Issues �j
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below El 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 VNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 5�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 J�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) []Yes KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ('(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes r\No
Additional Comments an orDrawings:
D� o�
% � I
- /�� % ✓ irlfV� a
5100

of Visit *Compliance Inspection O Operation Review O Lagoon Evaluation O Other
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification OO Other ❑ Denied Access
Facility Number 31 871
Date of Visit 2rz3rz0a0 Printed on: 3/23/2000
O Not Operational O Below Threshold
Permitted SCertified (3 Conditionally Certified Q Registered Date Last Operated or Above Tbreshold: .........................
Farm Name: )E t RIghtEarm.laz........................................................................... County: Dupfi................................................ '.W. JRQ.........
Owner Name:.... ................................................... -Eax1lx.Rigb1.k: j,.jAc ..................... Phone No: 2.1.0- ,4lG-tS.l..........................................................
FacilityContact:.............................................................................. Title:.................... ................ Phone No:
Mailing Address: 127.CkCkj)rke ................................................................................... Kenansxille C.................................................... 7.83.49 .............
Onsite Representative: StephenWilliamsm ................................................................ Integrator: MuMhy.,F.8mily.JFAr s......................................
Certified Operator: Step =M........................... WiM msen......................_.............. Operator Certification Number: .19128.............................
Location of Farm:
® Swine ❑ Poultry ❑ Cattle Latitude 35 " 07 51 u Longitude 78 " 01 02
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..........................................................................................................................................................................
Freeboard (inches):...............28...............................
❑ Yes ❑ No
E] Yes E] No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
............................
............................

Facility Number: 31-871 Date of Inspection 2/23/2000 printed on: 323/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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 4fi was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reaulred Records & Documents
17. Fail to have Certificate of Coverage &. General Permit readily available? ❑ Yes [:]No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WiJP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
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 ❑ No
;A -No• illoiaiicvn- & ar:di fkiericies• were: ri iid dui ing Niis •visii:: `Ynu will: receivi• :no fiirifier . .
..........................................................
.'��ri�esr3ripNprirw aluLiit'�Ri§•vicii:'. .
....................................
'om Freeboad Check. Mr. Williamson accompanied me while walking around the facility. Center pivot system was in operation at the
of my arrival. Facility is in good condition! Advised Mr. Williamson not to spray for at least a couple of days after today's
lication, therefore giving the field time to dry out well before another appplication is made.
iili:::.•�. :c;G:: ::i'
Reviewer/Inspector Name
:.:iC:L:n::}::. ::"+'.•i':� �:.`:::` n'^ i' is ri: i::J :::`-.......:.:.:...
..if.+.::.... ......: n's' iii:r: {.:: ..... :ri......
+:lsseer:lVicl�r.<>:

Division of Soil and Water'Conservation _Operation Review -
Division of Soil and- _Water Conservation Compliance Inspection
JNDivision of Water Quality Compliance Inspection
b
0 Other Agency Operaiew
10'-Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection Ci 24 hr. (hh:mm)
Permitted 0 Certified 13 Conditionally Certified 0 Registered 10 Not Operational I Date Last Operated: „.„.,.
�Q
Farm Name: .... J`� `- ........ County:....V�?.t-t............................................................
OwnerName:..............................................................................................................
Facility Contact:.............................................................................. Title:.............
MailingAddress: ................... ...............�..f..-�.1....`..........................................
Onsite Representative: , �'" S'-�...................
'Certified Operator:.........................................................................................
Phone No: .....................
Phone No:
....................................................................................... I.........................
Integrator:....... ...............................................
Operator Certification Number: ..........................................
at' n of F rrn
!................................. C ,4:...... ...Q............ .-.....-......................................... .............! ....................
............................................................ .......................................... ........................ I.....................
Latitude 0 6 S° Longitude • 6 64
Design Current ''' Design> Current Design Current
Swine _ Ca acit Population _
y Capacity:, Population __ Cattle .Capacity Population
Wean to Feeder
d v
Feeder to Finish14,60
Farrow to Wean
Q
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number oflagoons ❑ Subsurface Drains Presen# ❑ Lagoon Area ❑Spray Feld Area
Holding Ponds /Solid'Traps �. ❑ No Liquid Waste Management System ._
,... =
Discharges Sr Stream Impacts
1. Is any discharge observed from any part of the operation? .❑ Yes kNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes C�(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ry
Freeboard(inches): ........... -` .. ---..I ....................... ... ........................ I....... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued -on back
s

A.
, Facility Number: —E171 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
WNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
j(No
8. Does any part of the waste management system other than waste structures require maintenatice/improvement?
❑ Yes
J'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XM�j No
Waste„ Al2plication
la. Are there any buffers that need maintenance/improvement?
❑ Yes
�No
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
E' No
12. Crop type SG w
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
(9 No
b) Does the facility need a wettable acre determination?
❑ Yes
RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
j5No
15. Does the receiving crop need improvement?
Yes
M Ne�
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
' No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
O<No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
M No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
19 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
CirNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
NINo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
NJ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
1XNo
0; Rio violations;or• deficiencies vt� . * hOtea• daring this:visit. • Y;oix will r; eeeiye iriq further ; ;
corres�616dence: a�' ' f this visit. .. ..... .
Comments (refer:to uesti6n #1): -E larn an YFS answers an , r au -recommendations or.an other comments
W ._q xp Y Y y _ ,
Use:.drawings of facility to_better explaiin situations (use additionaUvage-s aswnecessary)
Ly �1 �2 r�e�c t.2w� a� ham+., . t om, CG- t�W4-
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

t 'Vacility Number: 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 5(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 P`No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes M 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 JKNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes $No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
Xdditional Comments anor ravings:
3/23/99

a 3 Q Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Routine 0 Complaint 0 Follow-up of DW2 inspection O Follow-up of DSWC review O Other �
Date of Inspection I v7-cile
Facility Number 3 t Time of Inspection q=00 24 hr. (hh:mm)
13 Registered Certified 0 Applied for Permit © Permitted 113 Not Operational Date Last Operated:
Farm Name:........ ...it .... fnrY''lr?? ......�"L............................................. County:
...... �.Lj)hr�...............................
.....
.........................
Owner Name:..................................lN�i�.4��n�eh................................... Phone No:...(1.1d).U..-..].51..............................................
Facility Contact: . ....................................... .............................. Title........................................... .... Phone No:
.... .................................................................
Mailing Address:_ .o......�Xa6...7.-i.G........................... ...� ..................... '�..
................ Z.S3. -O ............
Onsite Representative:........x`��.G.rrflY�.......................................... Integrator:...w.......
.........................................................................
Certified Operator................................................................................................................ Operator Certification Number:.........................................
Location of Farm:
Latitude Longitude �• �' �"
Design' Current Design "Current Design
Swine Capacity Population Poultry `' .capacityPopulation Cattle Capacil
® Wean to Feeder
Epp
® Feeder to Finish
p
LJ ayci
❑
K
❑ Other
Total Deg
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 gallmin?
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?
N
ISSLw
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fait to have a certified operator in responsible charge?
7/25/97 ?
❑ Yes ® No
❑ Yes No
❑ Yes MNo
❑ Yes W No
❑ Yes ® No
❑ Yes ® No
❑ Yes .91 No
® Yes ❑ No
❑ Yes No
❑ Yes ( No
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding Ponds, Flush Pits, etc'.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
Freeboard(ft): .............. 1.-!............... ................. ...................
10. Is seepage observed front any of the structures?
❑ Yes Q No
❑ Yes Ri No
Structure 4 Structure 5 Structure 6
............................................................................................................
❑ Yes EJ No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes 0 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) '
S
13. Do any of the structures lack adequate minimum or maximum liquid level markers" ❑ Yes ® No
Waste .application
14. Is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) _
15. Crop type........�kx.YNVAC.................... 'm(X.A......... o o,&A............---......_SQ ��t �....,....-.(n1 `ta ................ ...-...............- ....
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [11E No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ® No
18. Does the receiving crop need improvement? M Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes 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 [9No
22. Does record keeping need improvement? Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ® No
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
D.No.violations or deticiencies4ere noted during this.visit..You. wi11 receive no further
correspondence ah:oirt this. visit'.-.
Comments'.(refer'.to,gtrestion #) Explain any ITS Answers and/or any recommendations or any other comments
r
Use,drawmgs of facility to betterexplain situations: (use additional pages as neeessarv)
'S- �-(c t F� s�,r j el Cis, St'voU� 6e re-kar . W 4-'i-Grw&N S t rl S t� A of Ut 5WJ
`W - �o-Yc6S
1 c y C�.'C'�� •
12-- Ers,Or, o.vtpS br,`i-i.w4 odrer{ a!�, Mail 4t, (cya S6,4 be PIUd Gx,�yeseeri d-!&rz
`o-
4WY.Cii SY1QU� y�ei V`�S�BtiP�• �vu inY�.11r r7ii�l.. lr3a`iS�c7J�� ��.` Wi+Dui��.
11, �&x'MJG, S yLWO �Oe_ SO' i�� W1 30 d 01L_hl� a� I� CG 1 i OY� � 4'1$ f 48' L�'rSi c- N-
Z2- J&sk &4 Soil Saw4 araf yse% s fra Ger Zt• plat,, ej
7/25/97
" k
Reviewer/Inspector Nameyv
Reviewer/Inspector Signature: I Date: 41vcilig

140 rcouune 0 uompiamt 0 rouow-up of uwtl inspection 0 rouow-up of ubw4 review 0 utner
Facility Number
p Registered ■ Certified p Applied for Permit p Permitted
Inspection
Time of Inspection ® 24 hr. (hh:mm)
in Not Operationa Date Last Operated:
Farm Name: Earth.Right.Farms..Ine............................................................................ County: Duplin WIRO
Owner Name: Stephen .................................. Williamson ............................................... Phone No: 91fi-296-.151a ..........................................................
Facility Contact: Stepp,en..W.illiamson....................................Title: Gmuer ................................................ Phone No: 919:65&92Z3........................
Mailing Address: 121.0rcle.Drive................................................................................... Kenans.ville.,NC .................................................... 28M ..............
Onsite Representative: Stephen..W.Jlliamsan............................................................... Integrator: Murpthy:.FawiIy.Farms.....................................
Certified Operator: .................................................. .............................................................. Operator Certification Number:
Location of Farm:
Latitude ©a ©« Longitude ®• ®6 ®�
1. Are there any buffers that need maintenance/improvement? p Yes N No
2. Is any discharge observed from any part of the operation?
Discharge originated at: 13 Lagoon E3 Spray Field 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoonstholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
p Yes N No
p Yes p No
p Yes p No
p Yes 13 No
p Yes ® No
13 Yes ® No
p Yes ®No
p Yes ®No
p Yes ®No

ace ity um er: 31_871
8. Are there lagoons or storage ponds on site which need to be properly closed?
p Yes
® No
Structures (Lagoons,Holdinp_ Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
p Yes
N No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: ..................................................................................
.",,_
Freeboard (ft): 6
10. Is seepage observed from any of the structures?
p Yes
® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
p Yes
H No
12. Do any of the structures need maintenance/improvement?
13 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
p No
Waste Application
14. Is there physical evidence of over application?
p Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type........................Nana..............................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
p Yes
® No
17. Does the facility have a lack of adequate acreage for land application?
p Yes
®No
18. Does the receiving crop need improvement?
p Yes
®No
19. Is there a lack of available waste application equipment?
p Yes
®No
20. Does facility require a follow-up visit by same agency?
p Yes
®No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
®No
22. Does record keeping need improvement?
p Yes
®No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
p Yes
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
® Yes
p No
25. Were any additional problems noted which cause noncompliance of the Permit?
p Yes
®No
q .. yvidations.or erencies•were.note u"g Ys y!si . on wi .reeeive nor a er .
�ex>res�ioA�ierie �bati>� this visa-...... .......... .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: