660002_PERMIT FILE_20171231

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Tommy Flythe
Flythe Farms
Rt 1 Box 194
Seaboard NC 27853
Dear Mr./Mrs. Flythe:
I Noma
�EHNF�
December 27, 1996
F3�AM2I99�1
1 ;'.,,,: '
Subject: Removal
Facility Number 66-2
Northampton County
This is to acknowledge receipt of your request that your facility no longer be registered as an animal waste
management system per the terms of 15A NCAC 2H .0217. The information you provided us indicated that your operation's
animal population does not exceed the number set forth by 15A NCAC 2H .0217, and therefore does not require registration
for a certified animal waste management plan.
Under 15A NCAC 2H .0217, your facility is deemed permitted if waste is properly managed and does not reach the
surface waters of the state. Any system determined to have an adverse impact on water quality may be required to obtain a
waste management plan or an individual permit. You are reminded that a discharge of wastes to the surface waters of the state
will subject you to a civil penalty up to $10,000 per day.
Should you decide to increase the number of animals housed at your facility beyond the threshold limits listed below,
you will be required to obtain a certifted animal waste management plan prior to stocking animals to that level. Threshold
numbers of animals which require certified animal waste management plans are as follows:
Swine
250
Confined Cattle
100
Horses
75
Sheep
1,000
Poultry
30,000
If you have questions regarding this letter or the status of your operation please call Sue Homewood of our staff at
[phone] ext 502.
Sincerely,
0��_c
G� A. Preston Howard, Jr., P.E.
cc: Raleigh Water_Quafity eR geR gional-Office
Northampton Soil and Water Conservation District
Facility File
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources •
f
James B. Hunt, Jr„ Governor E:)EiHNFR
Jonathan B, Howes, Secretary
Steve W. Tedder, Chairman
December 5,1946
Tommy Flythe
Flythe Farms
RtIBox 194
Seaboard NC 27853
Subject: Operator In Charge Designation
Facility: Flythe Farms
Facility ID #: 66-2
Northampton County
Dear Mr, Flythe:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study Commission on
Agricultural Waste, was enacted by the North Carolina General Assembly on June 21, 1996. This bill
requires that a certified operator be designated as the Operator in Charge by January 1, 1997, for each animal
waste management system that serves 250 or more swine, 100 or more confined cattle, 75 or more horses,
1,000 or more sheep, or 30,000 or more confined poultry with a liquid animal waste management system Our
records indicate that your facility is registered with the Division of Water Quality and meets the requirements
for designating an OIC.
A training and certification program is not yet available for animal waste management systems involving
cattle, horses, sheep, or poultry. Owners and operators of these systems will be issued temporary animal waste
management certificates by the Water Pollution Control System Operators Certification Commission
(WPCSOCC). The temporary certificates will expire December 31, 1997, and will not be renewed. To obtain
a permanent certification, you will be required to complete ten hours of training and pass an examination by
December 31, 1997. A training and certification program for operators of animal waste management systems
involving cattle, sheep, horses, and poultry is now being developed and should be available by the spring of
1997. The type of training and certification required for the operator of each system will be based on the nature
of the wastes to be treated and the treatment process(es) primarily used to treat the animal waste.
As the owner of an animal operation with an animal waste management system, you must designate an
Operator in Charge and must submit the enclosed designation form to the WPCSOCC. If you do not intend to
operate your animal waste management system yourself, you must designate an employee or engage a contract
operator to be the Operator in Charge. The person designated as the Operator in Charge, whether yourself or
another person, must complete the enclosed application form for temporary certification as an animal waste
management system operator. Both the designation form and the application form must be completed and
returned by December 31, 1996.
If you have questions about the new requirements for animal waste management system operators, please call
Beth Buffington or Barry Huneycutt at 919/733-0026.
Sincerely,
FOR Steve W. Tedder
Enclosures
cc: Raleigh Regional Office
Water Quality Files ow'.,
Water Pollution Control System 1 �c
Voice 919-733-=6 FAX [phone]
Operators Certification Commission r VAn Equal Opportunity/Affirmative Action Employer
P.O. Box 29535 Raleigh, NC 27626-0535 50% recycled/10% post -consumer paper

w
State of North Carolina
Department of Environment,
Health and Natural Resources • •
Raleigh Regional Office
James B, Hunt, Jr., Governor C3 C � F1
Jonathan B. Howes,, Secretary C
Boyce A, Hudson, Regional Manager
Division of Environmental Management
September 27, 1995
Mr. Tommy Flythe
Route 1, Box 194
Seaboard, North Carolina 27876
Subject: Compliance Evaluation Inspection
Tommy Flythe Poultry Operation
SR 1325 Northampton County
Dear Mr. Flythe:
On August 15, 1995, Mr. Buster Towell from the Raleigh
Regional Office conducted a compliance inspection of the subject
animal facility. This inspection is part of the Division's efforts
to determine potential problems associated with waste collection
and disposal systems at confined animal operations.
Mr. Towell's site visit determined, that wastewater (runoff)
from your facility was not discharging to the surface waters of the
state, nor were any manmade conveyances (for the purpose of
willfully discharging wastewater) observed. As a result, your
facility was found to be in compliance during this visit.
Effective wastewater treatment and facility stewardship are a
responsibility of all animal facilities. The Division of
Environmental Management is required to enforce water quality
regulations in order to protect the natural resources of the State.
Accordingly, illegal discharges of wastewater to the surface waters
of the State are subject to the assessment of civil penalties and
may also result in the loss of deemed permitted status, requiring
immediate submission of a waste management plan.
This office would also like to take the opportunity to remind
you that while your poultry operation does not meet the criteria
for certification, you are required to maintain records of the
amount of litter removed and the location of where it is applied
by the poultry operation. Waste should be. applied at no greater
than agronomic rates and if at any time litter is to be stockpiled,
it must be located at a minimum of 100 feet from any perennial
stream or other surface waters as determined by your local Soil and
Water Conservation District. If third party applicators are used
records must contain their address and phone numbers.
38M Barrett Drive, Suite 101, Raleigh, North Carolina 27609 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/ 10% post -consumer paper

w
Tommy Flythe
Page 2
The Raleigh Regional Office appreciates your cooperation in
this matter. If you have any questions regarding this inspection
please call Buster Towell at [phone].
Sincerely,
-0Judy E. arr t
r'Water Quality Supervisor
cc: Northampton County Health Department
Northampton Soil and Water Conservation District
Pat Hooper--DSWC, WARD
RRO File Copy

• jUL-z4--199�; 15:26 FROM DEM WATER DUALITY SECTION TO
RRO P.02/02
Site Requires Immediate.Attenron-
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: k1 , 1995
Farm Name/Owner:
Mailing Address:
County: R/ u f
Integrator r t~ C_
On Site Re -presentative: -I
Physical Address/Location:
Time.. _� y
1 f-=(,, 4- 4 2
�;I
z7 -1.4
Phone:
Phone:
Type of Operation: Swine Poultry Cattle
Design Capacity: '2 0 o Number of Animals on Site: Brs7.
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:Elevation: Feet
Circle Yea or No
Does the Anima[ Waste Lagoon have sufficient feeboard of 1 Foot + 25 year 24 hour storm event
(approxirnately 1 Foot + i inches) Yes or No 4/�V- Actual Freeboard: /�l�Fz. Inches
Was any seepage observed from the lagoou(s)` CAS or No Was any erosion observed? Yes or No 41-�
Is adequate land available for spray'? 30or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: ` an, C221eS
Does the facility meet SCS minimum. setback criteria'? 200 Feet from Dwellings? or No
100 Feet from Wells? r No
'!.r arirnal waste stockpiled within 100 Feet of USGS .Blue Line Stream? Yes spray orLro
: a:rimal waste land applied or say irrigated within 25 Feet or a liSGS Map Blue Line? Yes o>Eo
animal waste discharged into waters of the state by than -made ditch, flushing syscem. or other
,irni!a.r man-made deN ces'? Yes u el —IN it Y ;s, Please Explain►.
')t res utc facility triaintain adequate waste nranagertient records (volumes of manure, land applied.
spray irrigated on specific acreage with cover crop)'. Ye or No
Additional Comments: CIAv Pi+-t G. �ftr, l/Y! /� �� Li�4',Zr
(31i1 - y ice- L1/0_d _C 4M s _ h r� b /af►ts �% �/
cc: Facility Assessment Unit
Signattue -
Use Attachments if Needed..
TOTAL P .1 2

1
State of North Carolina
Department of Environment,
Health and Natural Resources •
Raleigh Regional Office
James B. Hunt, Jr., Governor � C "
Jonathan B. Howes, Secretary C
Boyce A. Hudson, Regional Manager
Division of Environmental Management
September 27, 1995
Mr. Tommy Flythe
Route 1, Box 194
Seaboard, North Carolina 27876
Subject: Compliance Evaluation Inspection
Tommy Flythe Poultry Operation
SR 1325 Northampton County
Dear Mr. Flythe:
On August 15, 1995, Mr. Buster Towell from the Raleigh
Regional Office conducted a compliance inspection of the subject
animal facility. This inspection is part of the Division's efforts
to determine potential problems associated with waste collection
and disposal systems at confined animal operations.
Mr. Towell's site visit determined' that wastewater (runoff)
from your facility was not discharging to the surface waters of the
state, nor were any manmade conveyances (for the purpose of
willfully discharging wastewater) observed. As a result, your
facility was found to be in compliance during this visit.
Effective wastewater treatment and facility stewardship are a
responsibility of all animal facilities. The Division of
Environmental Management is required to enforce water quality
regulations in order to protect the natural resources of the State.
Accordingly, illegal discharges of wastewater to the surface waters
of the State are subject to the assessment of civil penalties and
may also result in the loss of deemed permitted status, requiring
immediate submission of a waste management plan.
This office would also like to take the opportunity to remind
you that while your poultry operation does not meet the criteria
for certification, you are required to maintain records of the
amount of litter removed and the location of where it is applied
by the poultry operation. Waste should be. applied at no greater
than agronomic rates and if at any time litter is to be stockpiled,
it must be located at a minimum of 100 feet from any perennial
stream or other surface waters as determined by your local Soil and
Water Conservation District. If third party applicators are used
records must contain their address and phone numbers.
3800 Barrett Drive, Suite 101, Raleigh, North Carolina 27609 Telephone [phone] FAX [phone]
An Equal opportunity Affirmative Action Employer 50%recycles!/ 10% post -consumer paper

Tommy Flythe
Page 2
The Raleigh Regional Office appreciates your cooperation in
this matter. If you have any questions regarding this inspection
please call Buster Towell at [phone].
Sincerely,
5
Judy E. Garrett
Water Quality Supervisor
cc: Northampton County Health Department
Northampton Soil and Water Conservation District
Pat Hooper--DSWC, WARO
RRO File Copy

Type of Visit: mom nee Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: � Routine 0 Complaintr� 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 0 r 3— Arrival Time: C3 p Departure Time: County: Region:
Farm Name: A41?ilvl 2� '2 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: C Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Illt �.
mill ryAe
1NNR � '
1
C
MINIM
ifll�.M
�lti�1H16191E111
�. II �
���vRdM:'��
Desrgn
1ililFil
Current
Design
Current
Current
SwineWpQjesj';n
apacity
fm
Pap.
�jyWet!Poultry
Capacity
Pap.
�II
Cattle.
Capacity
Pop:
Ni�C11�IRiiSi�
i,lll!!fi{(iKIiM
Wean to Finish
La er
Dairy Cow
I
Wean to Feeder
I
INon-Layer
Dairy Calf
FSgLer to Finish
Dairy Heifer
Z'Parrow
to Wean
/
Design
Current
Dry Cow
Farrow to Feeder
De ; P,oultr,
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
jPullets
I Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
ew.weawar...xrnwwi
i
�n.wxrxsw.w.+wire.wwsnwxwwwar®arairs.ouauxwxuiwu.�nn�xisr
rwru�.usuxinawuuxwir�ullwrxience=a
Discharizes and Stream Impacts
1, Is any discharge observed from any part of the operation? ❑ Yes Veno ❑ 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 ❑ 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) ❑ Yes W'N ❑ NA -❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

lFacillity Nufaber: - Z Z— Date of Inspection: p-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes❑
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No ❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, 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 o NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 <No NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 13e%/h hc1 —
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
e t
❑Yes
❑ N ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
d�4
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
VN
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
th b
appropna
❑ WUP ❑Checklists [:]Design []Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facie ity Number: Date of Inspection: L5 � 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 a ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ 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
[] No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
S
PO
??
Reviewer/Inspector Name:
Phone: C1 tq ? 91 L/ 2 Q CZ
Reviewer/Inspector Signature: � �C s fj2oL 704/ e
Page 3 of 3
Date: /Q — � — I
21412015

2-
Type of Visit: OWoutine
li a Inspection p Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 1
Date of Visit:J Arrival Time: ® Departure Time: County: Region:
I
Farm Name: A6 5 A�#? _� Z. Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: L" /Z IPll Q ert Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design C►urrent Design Current
Swine Capacity Pop. Wet Poultry C*apac1 Pop.
Wean to Finish Layer
Design C►urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder Non -La er
Dairy
Calf
Feeder to Finish Dairy Heifer
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [3Yes No [DNA ❑ NE
Discharge originated at: ❑ Structure ElApplication Field ElOther:
a. Was the conveyance man-made? ❑ Yes 5X0
❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes NA [3NE
c. What is the estimated volume that reached waters of the State (gallons)? J
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA [3NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued
Page 1 of 3 21412015 Continued

Facili Number: -Z Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N ❑ NA [3 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): S«
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, 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 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 Ej No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo/❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ,�r.r�'�
13. Soil Type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
ON ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
No NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ 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
❑ NA
gNo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the a ro riate box
pp p
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfe ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Inspection: Q -
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating' non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [] NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 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 ❑ No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
[]NA ❑NE
❑NA ❑NE
❑NA ONE
Comments ,(refer to question #) Exolki*han . YESianswers and/or aiiy additional, reconimendat!6iisaor any other cb`mments ;
use drawings of facility,to better explain situations -(use additional pages as necessary).
u �e
5'ur-vet �, /1-/7
k✓ = A . -73
co/eh,-eo-t, o, '2. z6 -r7
Reviewer/Inspector Name:
Phone: `? g1 ' t/ Z0 a
Reviewer/Inspector Signature: S t To-w e'11 Date: / � — r _ (
Page 3 of 3 21412015

o -t 2- - r C.
Type of Visit: 10 Cum ' ce Inspection Q Operation Review Q Structure Evaluation () Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Y � Departure Time:® County: Region:
1 Farm Name: R Zon3 L . Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Wean to Finish
I
I Layer
I
I Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
Dr. Pmoult , Ca aci P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
Other
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes No
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ YesVN❑
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) ❑ Yes o
❑ NA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes o N
❑ NA
❑ NE
of the State other than from a discharge`?
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard`?
❑ Yes
VNoNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): <<
7F5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environK
r at, 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 NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V NA ❑ NE
maintenance or improvement?
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, et
❑ PAN ❑ PAN > 10% or W 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): 15Y sti r 6e r r-t-ki d,*
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available'? if yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
NA
V
❑ NE
Yes❑
NA
❑ NE
[] Yes
No ❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
�No ❑ NA
❑ NE
❑ Yes
o ❑ NA
jNo
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement`? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FacilityNumber: - Z- Z- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 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
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
[] NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments=(refer to question #): Explain any, YES answers and/or,any additional recommendations or any, other comments.
Use�drawings of facility to better explain situations (use additional pages as necessary).
S(11A5e- S-3o -IG
o. A) �� �_ - I Z_ A
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

V,�
�b 0

Type of Visit: (D Co iance Inspection C.)Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:/, Arrival Time: [ Departure Time County: Region:
1Z30��
Farm Name: �� J �`� Owner Emai : Z
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: in'2 ( t-f f,2 KZ_' Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design
Wet Poultry Capacity
La er
Current
Pop.
Design Current
C•att[e Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oultr,.
La ers
Design
Ca aei
Current
$o P.
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Aullets
Beef Brood Cow
l - Herm
Other
Turke s
s
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes PNo
NA ❑NE
Yes ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: 66- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental Iireat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes W ❑ 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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes �VNo
[:]Yes
❑ Yes eNo
❑ Yes
❑ Other-
2 1, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 No ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: /( (/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
'<❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0.NA ❑ NE r
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 YesgNo ❑ NA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
0 NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
0 NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[,] Yes
[] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any -YES answers and/or any additional recvmmendations;araany other comments.�3'i
Use drawings of facility to':..better.explain situations :iuse additional paces as necessary):.,11
Yl e. r✓e 7 4
y
Reviewer/Inspector Name:
Reviewer/Inspector Signature: L[ S L U%.1 �— L(�
Page 3 of 3
Phone: 7 I , 4KZy U
Date: (14 I �/
21412011

Type of Visit: A Co fiance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /"`�'�`�"� 'Arrivai Timer Departure Time: �County: Region:
Farm Name: t�n a-,-- � Z---- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: C 14 P- [ ML�'��e •✓
Certified Operator: (27 i (� �� {3 � c r✓
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
De§ign Current
Design
Current
Design
Current
Swine @opacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Fa to Wean
Design
Current
Dry Cow
arrow to Feeder Z
Dr, P,ouEtr
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Tur,keX Poults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]-Yes
No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
N ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
[:]Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes❑
NA
rNo
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - - y Date of Ins ection: / 2'% /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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
3 Z
No Z❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ZINo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 <No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit`? [:]Yes EI-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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
J �
12. Crop Type(s): 13 e✓ M k C• Co
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required 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
gNo
❑ 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 VNo ❑ 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 o ❑ 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 21412011 Continued

Facili Number: Date of inspection: / L J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E]No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ' ❑ 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 ONco _❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ��o❑ NA ❑ NE
Other Issues
28. Did the facility tail 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
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
o
❑ 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
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain�any YES answers and/or any additional recommendationii'or any,other comments.
Use drawings offacilityto better explain situations (use additional pages as necessary). `
rV
Reviewer/Inspector Name:
Phone
Reviewer/Inspector Signature: I^ S (V G./e Date
Page 3 of 3
�Cj1 rf�2L,�
21412011

�' f6 ,:;-
Type of Visit: e(O'Coroutine
'nce Inspection U Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: ! 2;.- 3 Z---' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: % AA-7 1 AW-P Q 0.-1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Wean to Finish
I
ILayer
I
I Dairy Cow
Wean to Feeder
I
jNon-La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Di. l;oultr,
Ca .aci
Pxo ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
I lBeef Feeder
Boars
Pullets
I jBeef Brood Cow
'I'urke s
Other
Turke Points
Other
Other
Region:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PN ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes o ❑ 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) ❑ Yes rNo
NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes1�1'o NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
Ej
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 �[:] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
t�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j17NOo ❑ 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 eat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ON NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z <No❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): � l�E. M J'4 . S '0-1 q r A i'2 3
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [�] ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectiF]NA
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDate of Ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZoOEM]
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑Yes No NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ 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
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any_YES answers.and/or any, addition' al recommendations or,any other,comments,,'.
.�_ ;i; �.'.f �s
Use drawings of facility to better explain situations(use additional pages as necessary).,�
1J'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7 ! ` Z Op
Date:
21412014

(Type of Visit: Q rZoutine
pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name: 612- -, jj 2--- Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: &--6e_f G1 [.��✓ Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Design C►urrent
Swine Capacity Pop.
Wet Poultry
+Design Current Design C►urrent
Capacity Pvp. Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
Layer
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design Current DEX Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Turke s
Other
-Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes YN!
❑ NA ❑ NE
b. Did the discharge reach waters of the State`? (if yes, notify DWQ) []Yes ❑ 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) ❑ YesrNo[]
NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes NA ❑ NE
of the State other than from a discharge?
Page 1 of 21412011 Continued

Facility Number: - Z Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
3 Z_
V NA
❑ NA
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 No ❑ NA
[:]Yes No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Yo ❑ 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 ZN ❑ NA ❑ NE
maintenance or improvement?
Waste ARPlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes rNo[o]
NA [] NE
maintenance or improvement?
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): d r, Y,rn q r af., S , Ga'' n
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
-n ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNo ❑ 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
Z[:] 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers VNo
WeatherCode
❑Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectiSludge 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❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes NVNo
❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
5Z
❑ NE
❑ NE
❑ 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 r] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 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?
❑ Yes ❑ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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 ❑ No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No
❑ NA ❑ NE
Reviewer/Inspector Name: Phone: 72Z- V z'�c>
Reviewer/Inspector Signature: s� 1��� ^T Date:
�---
Page 3 of 3 21412011

i2�i(Ct
2
Type of Visit: UCom a Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral Q Emergency O Other Q Denied Access
r--
Date of Visit: �t- It Arrival Time: b Departure Time: County: Region:
Farm Name: 15� iz r+ 3 2— Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: G W e_1 6R Lt P. e_ P7
Certified Operator: i3 4 it L',-1-3 A )
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
;Design
Current
Design C*urrent
Swine Capacity Pop.
Wet Poultry
C a P city
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Fa w to Wean
Design
Current
Dry Cow
arrow to Feeder
ZD
Dr P�o_ultr
C cit
Pop.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
113eef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Vo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[]'No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
• [DNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
FNo
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 - 21412011 Continued

Faclil ity N uM ber: & & - Z- I Date of Inspection: I 2. L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 10No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ef No ❑ NA ❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soi I
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. CropType(s): t;er,-i J4,5An4)rA}-J
13. Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3`NNA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
A
❑ 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
❑ 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
5 NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall InspectioeNo
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❑ NA ❑ NE
Page 2 of 3 21412011 Continued

3Z_
Facility Nuanber: & 6 - 7 7_ I Date of Inspection: (// 22 ( If
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �NEo]
NA [3 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 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? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[] No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance ofthe permit or CAWMP7
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
❑ No
❑ NA
[] NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES'auswers and/or any additional recommendations orany other comments V Wl
Use drawin g s,of facility to better explain situations use additional pages as necessary).
,944� ZvVe
fir- ;q3
D ^ 3 '3 2
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: �3 �S>� rl� Lr Date:
Page 3 of 3 21412011

Z
Type of Visit Pfco lance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: iri(—I,1 u Arrival Time: �3r Departure Time: County: Region:
Farm Name: �r Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative A r
Certified Operator: C Le AG��- �l t r%
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ c =, = « Longitude: = ° = d = u
Design 0--u rmen tj
esign Ourgent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
10 Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Far -to Wean
Dry Poultry
❑ D Cow
arrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
El Gilts
❑Non -La Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ TurkeyPuuets
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes No NA ❑ NE
Yes No NA ❑ NE
❑ Yes N A ❑ NE
El Yes ❑ NA ❑ NE
[3Yes No El NA ❑ NE
Page 1 of 3 12128104 Continued

I
Facility Number: —� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes . No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. U Yes JQNo U NA LJ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo ❑ NA ❑ NE
23. If seiected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesVN;o,�__]
NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ YesNA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ 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
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
4c--i, : 4i 'o .. f- /r-c, S� �-
�7u � m ;< f �0 c� —� {� � � C Q �✓,� / G FF, Gar pr i a r- —�-� � n^ p ,(2 ►w¢ h ate. � �-r
•
Page 3 of 3 12128104

Facility Number•
Date of Inspection Z L
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No NA ElNE
El Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ 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 ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No ❑ NA El NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZrNo ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment?
❑ Yes
LN >0 NA ElNE
❑ NA ❑ NE
o❑ NA El NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer tolquestion #}: Explain.any YES answers and/oryany rec�omme�n�dahonIS
ortany 4oit er comments
Use.drawings of facility�to_better explain situations. (use addtttonal pages,astnecessary)
.�.x�as_S$4:����
Reviewer/Inspector Name {(+.p '. Phone: 7L -/2o-C2
Reviewer/Inspector Signature: 66t 71V es g== Date: I,/
2Z h
Page 2 of 3 12128104 Continued

W,
Type of VI&It (!�;Routine
m ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: b�Lti- 3 Z� _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: W- Wr✓r
Back-up Operator:
Title:
Phone:
Phone No. -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 1 0 Longitude: = ° = d = 11
Design Current
Design Current Design C►urrent
Swine Capacity Population
Wet Poultry
Capacity Population Cattle Can—ty Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
Non -Layers
❑ Pullets
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
El Farrow to Finish
❑ Gilts
❑ Boars
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
,��
J N NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El 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)
❑ YesjNo
N A
El NE
2. Is there evidence of a past discharge from any part of the operation?
ElN
NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lr
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?
ElYes�No
No NA ❑ NE
El Yes ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes o ❑ NA ❑ NE
❑ Yes J2 �o[:] A ❑ 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 ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes // o NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑yes No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P�No-NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
t3. Soil type(s)
E.L'A�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application`? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
'❑ No ❑ NA ❑ NE
Ala NA ❑ NE
FNo
❑ NA ❑ NE
NA ❑ NE
ElNA ❑ NE
Comments{refer to qut s#�oii #) Expla any YEfS answers and/on any,recomme5n4dnaso any other comments:
1,Usejdrawmgs of facility tWbetter ezplatn srtua�?ti>>ons (use additional pages as.neceAgssary):
t jjx A�:,�(-V'iBv.0 ���.
f
Reviewer/Inspector Name ---- Phone:
Reviewer/Inspector Signature: Date: (]
Page 2 of 3 l2/28/U4 C.'ontinuea

r
Facility Number: — Date of Inspection(/ d 1 D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1GfNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �`No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Id N ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA [INE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes El NA [I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes No NA El NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No NA El NE
El Yes No ❑ NA ❑ NE
AdditionalComments�andlorDrawings i:lac ii'.,''`.rt=
f
Page 3 of 3 12128104

t7 ( 6
Z-
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Vlsit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: G J Departure Time: County:
Farm Name: rt �`� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: &-A h C� n
Certified Operator: 4 ✓} �''� Q 5' _►1-5
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = g Longitude: = ° = 1 = "
Swine
Design Current
C►apacity Population W"IF,oultry
Design Current Design Current
Capacity Population Cattle Capacity Population
Finish
❑ Layer
❑ DairyCow
to Feeder
❑ Non -Layer
❑ DairyCalf
r to Finish
❑Dai Heifer
Eto
w to Wean Dry Poultry
w to Feeder [ $
w to Finish ❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys ❑Turke Poults ❑ Other
❑ D Cow
El Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ;;No
<,7EEI NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes 6 ❑ NA [I NE
El Yes Vo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 n Continued

Facility Number: — Date of Inspection 2/ts
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 Zo,, ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No NA ❑ NE
❑ Yes o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Vo NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes o ❑ NA El
El Excessive Ponding El Hydraulic Overload El 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) I:JG� rr l 4 r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes Z]No/'❑NA [I NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � ❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? El Yes ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ElYesflNo ❑ NA ❑ NE
Comments (refer to question#) Explam ariy YES answers and/or any recomm.enditions or any other comments. 1 €
Use drawingsof;facilify fo better ezplatn situations ,(use additional -pages as°necessary,): r
ReviewerllnspectorName ? '� Phone:
Reviewer/Inspector Signature: S 4 Date: / 2/
12128104 Continued

Facility Number: 64 — Z Date of Inspection MZ5
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes PNo ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ eather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes'No,,O NA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYesVNF_1
'El NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El❑ NA [I NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes
NA El NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Rainfall ❑ Stocking
[:]Yes No j
NA ElNE
❑ Yes No ❑ NA ❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Cl Yes
❑ No
❑ NA
❑ NE
Additional�Commefits,`andlur;Drawfngs;"q�
r L n 4 - f�Y' �I 0 -AlC rP .5
-Z o t oH,
12128104

Facility Number
Division of Water Quality 5 r3
0 Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Comp ' ce 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: Arrivai Time: L I Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 0= I= Longitude: 0° =' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I i' JE1 Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ 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 e
Cattle Capacity' Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: F J
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?
®I
❑ Yes No ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
[-IYes No ❑ NA ❑ NE
❑ Yes FN0o
El NA [I NE
❑ Yes[INA ❑ NE
El Yes❑ NA ❑ NE
12128104 Continued

Facility Number:9,,,, — 22 Date of Inspection-�---
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o 01
NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �{
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo-,OA ❑ NE
maintenance/improvement?
1 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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) t'�M5-rffj, rid{" I-, S
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
N NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
N NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phon 7�1�-'-/ZOO
Reviewer/Inspector Signature: 0 — z— Date:
12128104 Continued

Facility Number: . — Date of Inspection D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes "NoNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ W UP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspection�No
Bather Code
22. Did the facility fail to install and maintain a rain gauge? El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes7N9,1El
Cl NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El NA El NE
26. Did the facility fail to have an actively certified operator in charge? El Yes;XNX
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes NA ❑ NE
Other lssues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments and/or
3 Z12128104
�

Facility Number
vision of Water Quality
O Division of Soil and Water Conservation
Q Other Agency
Type of Visit lo;Routine
ante Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �C Arrival Time: 7 Departure Time: County: Region:
Farm Name: CM&P- 7 ..._ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:C .4_ IV ►4 �j
Back-up Operator:
Location of Farm:
Design Current
Capacity Population
l...J Wean to Finish
❑ Wean to Feeder
4-
0 Feeder to Finish
❑ Fafrow to Wean
Farrow to Feeder 00
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other*
Phone:
Title: Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 f 0 Longitude: 0°= A=«
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes � NA ❑ NE
❑ Yes No [ NA ❑ NE
❑ Yes VoO
A ❑ NE
El YesA ❑ NE
❑ YesA ❑ NE
12128104 Continued

Facility Number fi 7
Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes "No
A ❑ NE
❑ Yes ❑ NA ❑ NE
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 ElNE
(iel 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 �r,otify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes ' to El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No E NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Win ow ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
T'
13. Soil type(s) -I--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
I,d No .: ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J2<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:
Reviewer/Inspector Signature: Date: 3 Z
12128104 Continued

I
Facility Number: Z Date of Inspection rZ d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No �NA El
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropiate 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 1" Rain Inspections UWeather 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? ElYes L4 Nqp, ElNA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYesrNo
NA El NE
26. Did the facility fail to have an actively certified operator in charge? El Yes NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

. , ;%
Fadlity:Numl er Z
-' -
V.
U
ADrDivision of Water Quality
Q Division of Soil and Water Conservation;
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: rqi 0-f I Arrival Time: Departure Time: County:
Farm Name: 12A_ �j. Z_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Phone No:
Onsite Representative: Integrator:
Certified Operator: ""� �,� Operator Certification Number:
Back-up Operator:
Location of Farm:
F
�} Design C
�wme� ' Capacity Pol
] Wean to Finish
] Wean to Feeder
] Feeder to Finish
] F to Wean
arrow to Feeder Z p
] Farrow to Finish
] Gilts
] Boars
)ther
Other
Region:
Back-up Certification Number:
Latitude: = o = 5 = Longitude: = ° 0 4
rent. `Design Current a'�' �'F �Desrgi
attoa Wet Poultry. Capacity Population,-," ~Capac
❑ Layer
❑Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
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?
❑ Dairy_Cow
El -Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
f Number of Structures �r'�"�'�jI �"
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 ONo ❑ NA ❑ NE
❑ Yes ZNoNA El NE
[I Yes o El El NE
❑ Yes No NA El NE
El Yes o A ❑ NE
❑ Yes o ❑ NA ❑ NE
12128104 Continued

. r.
Facility Number — Z-
Date of Inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ✓'r
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ";NoNA ❑ NE
Yeso ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes o NA ElNE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes .Vo[O--
A ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ YesA ❑ 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)
S'nat r A-1 rn 3
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J No ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
No NA El NE
o ❑NA ❑NE
Comments (refer to question #):.Explain any, YES inswers and/or any recommendations or=any other comments � � �� ��a _�
Use drawings of facility to better explain situations: (use additional pages as necessary)::''
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature: Q/
Date:
y' 1 y v�
Page 2 of 3 r 12128104 Continued

.. y
Facility Number —Z,.2 _ Date of Inspection 1.141( R
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes rNo
NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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 Inspectioi;UrZOE]
eather Code
22. Did the facility fail to install and maintain a rain gauge? El El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes o ❑ NA El NE
26. Did the facility fail to have an actively certified operator in charge? El Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (.PLAT) certification? ElYes No NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ 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

Type of Visit Comp! a"Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit out
O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: // Arrival Time: � / � Departure Time: County:
r
Farm Name: h— / z-- _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:._ L 4-2'11�— V— LL
Certified Operator: H. 4 �jCP/L+�l>�
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = 0 = I = Longitude: = ° = ` = {I
Design Current
Design' Current
�, Det'isignCurrent
Swine C►►opacity Population
Wet Poultry
C«opacity Popilation
Cattle r Ca , ci
Poulahon
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑Dairy Heifer
❑ F w to Wean
Dry PoulEr:y
❑ Dry Cow
Farrow to Feeder
Z
❑ La ers
"''
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
I
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
;
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
��
.
El NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
VNo
❑ 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
El NA
❑ NE
2. is there evidence of a past discharge from any part of the operation'?
❑ Yes
�O,
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ZNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ YesNo__2
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes
No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2No ❑ 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
No ❑ NA
❑ NE
8. Do any oft he stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
[] Yes
ZrNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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 typc(s) 6Prih4,CIA , S�-NgAq r n S " 6-ov- n , fa) h0%,h t
13. Soil type(s) %7
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of property operating waste application equipment? ❑ Yes
No ❑ NA
� �'NNo El NA
l_J No ❑ NA
E El NA
WNo❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to q�u�estion #) Explain any YES answers and/or any recommendations or any other comments.
i tip Y .J� .{S v]£ f h
Use drawings of facrlity to�hett I. explain sitivations. {use additional pages as necessary};
ft
Reviewer/Ins ector Name w
p� Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: —Z
Date of inspection 11 6
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ZNo ❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
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
No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo ❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No C?NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2rNo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Continents°and/or'9Dr"swings H "z
rc 9 I . �+ r 7 %+pY U.S `4e
C7v\ ge4 0 f 0 CG eI.5 e -1 , 4f -C Al,.d.T-� ,' S "/Iv- do =+
12128104

(Type of Visit 4 ComplLapoe'inspection O Operation Review O Lagoon Evaluation j
Reason for Visit - 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
II ""III'll I■ -,■I Date of Visit: .S G Time:
Facility Number Z-
Q Not Operational Q Below Threshold
ermitted O Certified ©Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: . ...:2 .,... 0...:3...Z..-
................................................................ County:........................................................................
Owner Name:
Phone No:
MailingAddress:...................--•---......,........._......................_................................................................................. ..................................................... ..........................
Facility Contact:..............................................................................Title:............................ Phone No:
OnsiteRepresentative: ........................................................................................................... Integrator: ................................................................................. I ....
Certified Operator: P,4 �1... .......��t!��f P r-................................. Operator Certification Number: .........................................
... ...... .....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • 4 64
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes o
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? ElYes Nq/
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structur
Identifier: ................................... ................................................................................................................................................................................
Freeboard (inches): L l
12112103 Continued

Facilityumber: —L.Z. Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Cl �o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes o
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 o
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 El Yes o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ YesVo
I i . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yeso
❑ Excessive Ponding ❑ PAN []Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type J5 Q i .n k J q SN+ r r4
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?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18: Are there any dead animals not disposed of properly within 24 hours?
19, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes o
❑ Yes o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
n•°6z , � �«<. ,° , . „s y','. , ,: - • `v-S°l.4.ri-atE3! 7t,t €4t�Y€ t tl�tR..P .",it3! lilt tt€:: :t§ U i m6ii€1.6:�°°i&i°,i ';.€. �;r4:s"t i.l', 4£a 1.. a g.:° °. z:!zt,€ . F.:,. F'..:x i E fit,<E,'. � 1 -f
Coaunen'`{refer`" to qu'eshon',#}Expla any YES;answerssindlor'ariy recont7nertclatioas or eery othe`commeflts.€`yj� 'EF ' €q(', �'' ;,"j
t>,: � ,1: s Y liiH 'fir^ '�.h4'+1x4"- '*tli+.,i�i'- r. '�-,� _ �° +; i" ��ili lli,litll�' ,a 3:e�+, :%i' •>is''iu''� }�l:-�r�:1 �9"r _L �� � iSvs:,M�::�i.— Win... �rx�wE.uf>�s....`d�a�.Ls.'`{",�'ia ril-', I
{Useidxaw»ugs o£Eiacilitytto'better explaaau sYbuairous {uise�add�t�onal pages'as;necessary).s Feld Co ❑Final Notes'' !"`I"
{, ! §-0°
> ! is is s�E.t S g .s .a °d, !a E �, : �< f a , .RE � � � - -.3 a.Et. , , i" !> Ila iE t a i_.,ix .. s c � 6 n4fg �.� < �� � € I i .ti, i. stE€..i � e sa.n e n �K< �cE +^,n+::+•iE . +c� a E�. =ne�wrt,i. ai , !9; t s
E,E a:si.
is�..3,rin�...�se�,,...5..�114;,a„i,-,:..,P .�i.�,i,....,.L �rri!...a..vi9�,,i=�.a.e,e.��'e„�S�,zha,>�.�R�,r.,,o,�lila��€�a8€iia�i;�tss�l.,tm3at�°1<Li..:€tes,i e<.��>��s-t.tr=xeeva.v.•ie..,l,yi���...a..le$''.�,-s.�ua� siii.,<4:ii.,tstr-t..,�.11s`iia.ai.;�iiev3:,,a:;,:t�ttslSYe:;L.
gay
ReV1eWCCgnSpeCtOr Name
Reviewer/Inspector Signature: Date:
G:onhnued

Facility Number: v 7 _ Z Date of Inspection
Required 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?
(ie/ 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?
NPDES 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
i
❑ Yes l0Q
❑ Yes i<o
❑ Yes
❑ Yes o
❑ Yes o
❑ Yes ��No
El Yes
❑ Yes ❑'No
❑ Yes
❑ Yes 21No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit CSCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Xacility Number Date of Visit: z Time:
Not O erational Below Threshold
Permitted DCertified [3 Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: 3 -Z— County:
Owner Name:
Mailing Address:
Facility Contact:
Phone No:
Title: Phone No:
Onsite Representative:
Certified Operator:
Location of Farm:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' �` �" Longitude 0• ��66
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Ca i%ci ' Population
❑ Wean to Feeder
JEJ Layer
I
I
IE] Dairy
❑ Feeder to Finish
❑ Non -La er
I
I
IQ Non-Dai
❑ Farrow to Wean
T-
-
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
�
❑ Gilts
I
El Boars
TotaLSSLW .
V
g p �,
❑ Subsurface Drains Present ❑ La aon Area
Number of,Lagooiis ❑ S ra Field Area
4
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Di5charQe§ & Stream Impacts
I. 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 B& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
t�
Freeboard (inches):
05103101
❑ Yes
ET No
❑ Yes
No
❑ Yes
to j
❑ Yes
Z
ElYes
❑ Yes
No
❑ Yes
o
Structure 6
Continued
i

Facility Number: 7,07re— z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ witl'i those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reduired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes eN,
❑ Yes No
❑ Yes po�
❑ Yes
El Yes
❑ Yes N
❑ Yes No
❑ Yes _[3'No
❑ Yes
❑ Yes N
❑ Yes No
❑ Yes l_�N0
❑ Yes No
<.❑ Yes allo
❑ Yes No
ElYes .1
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (i=6er to: questi6n #): Explain spy YE5 answers and/or any "recommendations o"r any:otheracnmments.
sari , : , ,d, y
Use drawings of facility to better explain situations (use additional pages as necessa,nr�y�): " ❑Field COUP ❑Final Notes
f�Y%r7 /� SG' i e � Y L' /� " c �� �% a�� `� �12- Z /1 Ge, ��r s? �•'�
fil/o-1q f /i
rr
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Y
05103101 Continued

I
Date of Visit: me:
E22-
Facility Number
rO Not Operational 0 Below Threshold
Permitted [3 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: _�i- 4 4 2Z County:
Owner Name:
Mailing Address:
Facility Contact:
Title:
Phone No:
Phone No:
Onsite Representative:
�� Integrator:
Certified Operator: Oyt n j �-" Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 u Longitude �� �4
Design Current Deslgn Current IYsign Current
Swine Capact Population P,ouit . Ca aci P,o ulation Cattle Ca act P,o ulation
❑ Wean to Feeder I EID Dairy
❑ Feeder to Finish I Non -Layer I I MIQ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish �{ ` r Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of HLagoonsFz�=EJEJ Subsurface Drains Present ❑ Lagoon Area Spray Field Area
olding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & StreamImpacts
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes No
❑ Yes
❑ Yes No
❑ Yes
ElYesVNo
ElYes Yo
ElYes No
Structure b
52to,
Continued

., - 4
Facility Number: — Z L 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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop hype Lf 471wha- L . li ►•^ A L-1- ( I -)
❑ Yes JYNo
❑ Yes o
❑ Yes 5No
ElYes
❑ Yes ;<_�z
❑ Yes jN
El Yeso
13, Do the receiving crops differ witllthose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 2rN0
14. a) Does the facility lack adequate acreage for land application? Cl Yes J4 No
b) Does the facility need a wettable acre determination? ElE Yes N
c) This facility is pended for a wettable acre determination? El Yes 6<o
15. Does the receiving crop need improvement? UF7es r o
16. Is there a lack of adequate waste application equipment? ❑ Yes 4
Required Records—& Documents /
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? El },-L(-,,N(o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Y No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) j es 2N�
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
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
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
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
q �) " p `'y E9 nswers anc or a y recommentlations or�any oth mments Comments.{r fer "to" uesti'tinEx Cain an Y
Use"drawings of facility to better explain situations.{use additional pages as necessary} . ` Field Copy ❑Final Notes
=,. ... ;
S,�,jW C�1 S }�i-L c.�. , f f -4 , -F L�-u�� ,/ Cie . A- e_K '1-/ '
Y C'L✓ 4 �� t`i✓i� tz 1 J p� �• CL n� r�i �s-�—r
'�� I w�v s�
-4-j Fe r •
/a-Z. — J �, •. �• �tU fr rJC.�-� vl .ee cf c�Lg �y,t s�f�9;+ / rF rZ w d L N
Reviewer/Inspector Name K
Reviewer/Inspector Signature: Date:
05103101
Con ued

, - -
Facility Number: — Z Date of Inspection
or Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Noo
29.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
IdNo
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
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
o
3 l .
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
o
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
o
Addition
a . amments and/or. Drawingsi
4-65- 44W �-, p i Js
05/03/01

Type of Visit
Reason for Visit
O Operation Review Q Lagoon Evaluation
O Complaint. O Follow up O Emergency Notification O Other 1 ❑ Denied Access
Facility Number Date of Visit: Time:
Q Nat Operational Q Below Threshold
rmitted © Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: ............
FarmName: ..... .�.�1r...........................................................................
Owner Name:
FacilityContact:.....................:........................................................ Title:
Mailing Address:
County: .............................................
PhoneNo:......................................................................................
Phone No:
Onsite Representative: ...................................................................................... Integrator: ....... (�1...
Certified Operator :.,,,„�z.......v.
� �� .. ......................... Operator Certification Number:
..............^..1..P..r:..................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• ��
Current Design Current
r„ iPopulatton`' . `'Poui#ry Capec . Po_ pulahoo . Cattle
Wean to Feeder
Feeder to Finish
Farr -to Wean
arrow to Feeder
Farrow to Finish
Nnrnber'of Lagoons ' , ❑ Subsurface Drains Present ID Lagoon Area . ❑ Spray Field Area
Holding Ponds / Solid Traps: ❑ ;. No Liquid Waste Management System
4. �i.
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..............Oe... h.............................................................................. ........................
Freeboard (inches):
5/OD
❑ Yes
❑ Yes rzz
❑ Yes
❑ Yes PAC
❑ Yes zo
❑ Yes o
s
❑ Ye No ..
Structure 6
Continued on back

Facility Number:ZZ_ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes o
❑ Yes o
❑ Yes o
❑ Yes No
[]Yes o
❑ Yes VNo
oYes
12, Crop type ems, /n
13. Do the receiving crops differ th 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 o
c) This facility is pended for a wettable acre determination? ❑Yes No
15. Does the receiving crop need improvement? ❑ Yes o
16. is there a lack of adequate waste application equipment? ❑ Yes o
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes a
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 N
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes N
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
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
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes N
24. Does facility.require a follow-up visit by same agency? ❑ Yes
25. We any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ❑ No
i9ris o - k'j' ' ' . '5 *Vre la�ed1 dtrririg thIs'vjs1tf • X60), iil•teeoiye 00 fp>1•t�lgr: •'
corartrsnoric ence: a�ouk this visit: ................................... .
Use drawin' of facili to. ( ' 1^
gs h' , betier�explain situations use additional pages as'nec ) ,� '; ;
�. �<°,a�.i Ea€�4i i ark a
A.
/�g
Reviewer/Inspector Name
Reviewer/Inspector Signature:
a 411 j 3 _ kF_ } Lt fy 'i "P19N Et`�{5E agvt
4 3
Date: (/ L S/{gyp

Facility Number:64_ Date of .Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes o
26. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ZNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes
,. one omments'8n or:. rawi lg5:[F: t E� si'' tt Y u spa ni i
��
i1
J
5/00

Nn
0 E i6 , .. iii ... .
D>vis�on of Soil and'Water Conservation% Operation Review a ,_s
Q;'Dl Of SOII and,.WateF�CO115erVatlon - �Ompliance Inspection aE rji.
i >.v>;sion of Water „Quality ComplianceTnspection ' E FM
OthertiAgency Operation.,Review.E.,..'.x. ,
.rt_
101l;outine Q Complaint O Follow -tip of DWQ inspection Q Follow-up of DSNVC review 0 Other
li'acilit}' tuber Date of Inspection
I'irMrt: of, Inspection l/36 24 hr. (hh:mm)
Ca'11'ermitted [3 Ccrtified [] Conditionally Certified © Registered JE3 Not Operaational Date last Operated:
FarmName: �..2. .............3.z.. �& ................................... County:....................
OwnerName:..................................................................................... ...................................... Phone Nro:..,..............,.....................................................................
Facility Contact:...1�1119�.!/!.^..�.Q.!�.............. Title Phone No:
MailingAddress: ............................................................................................................... ..........................
OnsiteRepresentative:.................................................................................................. Integrator:......................................................................................
Certified Operator:...... , Operator Certification Number: ..............
....................................................................................... ............................
Location of Farm:
i
............................................ ..................................................................... .... .........
Latitude �•�4 .4 Longitude • 4 64
rrent
swine
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
U'lilarrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer .� ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. 11" discharge is observed, was the conveyance rnan-made?
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. [I' discharge is observed. what is the estimated flow in gal/inin7
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than froth a discharge?
Waste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
ldentrficr:
r r
Freeboard(inches): ........ZZ............................ .................................... ................................... ..............
❑ Yes
❑ Yes
❑ Yes afl o
❑ Yes 0<0
❑ Yes No
❑ Yes No
❑ Yes No
Structur•c 6
1 /6199 Continued on back

Facility Number: tod — �.� Datc 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 pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need nrriietenance/improvement'?
1 1. Is there evidence of over application'? ❑ Ponding ❑ Nitrogen
12, Crop type ge �.. w+ ....................................... �............�... ...........
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acrcage for land application? (footprint)
15. Does the receiving crop need improvement'?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, free boarj-pFohic'ns, over application)
23. Did =Revicnspector fail to discuss review/inspection with on -site representative?
24, Doequire a follow-up visit by same agency? .
o.vialations.tir. deikiencies .were noted, dtiring.tiiis"visit:. Y'oti vvilfretveive nar Mrther...:
•�•egrrespq�idence;ta,bout"this visit.;•••••,-;�;•;•;•;•;•;•••••;•;•:-;-;•;•;•;-•••••-;-;�;�:.:.;.;.:.:.. . .
1
❑ Yes L�`I""
❑ Yes 2 ` O
❑ Yes 0 0
:�_
❑ Yes �No
❑ Yes _Q' O
El Yes o
❑ Yes ;�O�
❑ Yes .t`�o
❑ Yes
❑ Yes Jt Nl
o,
❑ Yes
❑ Yes
❑ Yes No
ElYes fo
❑ Yes ailo
❑ Yes 21No
❑ Yes
❑ Yes ;/N
❑ Yes XNo
Comments (refer to question#): Explain any YES answers and/or any: recommendations or any other comments,,
Use ations. (use additional pages as necessary):! drawings ;of facility to better explain situ
A
Reviewer/Inspector NameTr
Reviewer/lnspector Signature:Date:
1 /6/99

ytJ '• �
Facility Number: 6 — �, Date of Lispection O�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
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.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
�esoo
❑ Yes No
❑ Yes No
❑ Yes
❑ Yes VNo
ro,,,
❑ Yes
Yes ❑ No
it

M
2 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other j
Facility Number Date of Inspection ' z
Time of Inspection 24 hr. (hh:mm)
0 Registered 0 Certified 0 Applied for Permit [3 Permitted 113 Not Operational Date fast Operated: .
Farm Name: / s+ , Count „(i'
{.:.�......4�......�.......................................................................... y' ...,' 2 T...rf�'......r t~[:.
OwnerName................................................................ Phone No:.......................................................................................
FacilityContact ...... Title: ................................................................ Phone No:...................................................
MailingAddress:................................................................................................................................................. ..........................
Onsite Representative:A....... .1.............................................................. Integrator:......................................................................................
Certified Operator..................................................................... Operator Certification Number-, ...............
Location of Farm:
Latitude �' �; " Longitude • 4 61
Deltsrgn Cp rrent
'Clap
ign Current
Design Current
Swine Capacity Po ulatton
Poultr y
acity Population' Cattle x;i
Capacity" Population
❑ Wean to Feeder
❑ Layer
•
Dairy
❑ Dai
;`°
❑ Feeder to Finish
❑ Non -Laver
10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
" Total Design Capacity::
❑ Gilts
❑ Boars
Total SSLW
r
N. umber of Lagoons / Holding P6nds I kJO
Subsurface Drains Present
❑ Lagoon Area
❑ Spray Field Area
�--
n. " ' r
No Liquid Waste Management System�
'
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
PNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
0 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
[?No
c. If discharge is observed, what is the estimated flow in gaUmin?
d, Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
(YNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
VNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No'
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
d No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
❑ No

,. Facility Number: — 7/'54-1
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes /P� No
Structures La oons Holdin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? f1 Yes El No
Structure l Structure 2 Structure 3 ;structure 4 Structure 5 / Structure 6
Identifier:
....................................................................................................................................... I ...................... I.... .... I..............................
Freeboard (ft): �, f /.......................................................................
10, Is seepage observed from any of the structures? ❑ Yes ❑'No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 9No
12. Do any of the structures need maintenance/improvement? ❑ Yes /VNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify OWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ;2rNo
Waste APplicatiort
14. Is there physical evidence of over application? ❑ Yes PNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type.........................................................................................................................................
16. Do the r ceiving crops differ with t ose deli nat�I in the Animal Waste Management Plan (AWMP). 0 Yes No
17. Does the fa ' ity have a lack of adequate acreage for land application? ❑ Yes 1;1'No
18. Does the re, tvrng crop need improvement? ❑ Yes 010
19. Is there a lack of available waste application equipment? ❑ Yes El&o
20. Does facility require a follow-up visit by same agency? f1Yes ❑ No
21. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes ZNo
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 'A 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 ❑ l�
0 - No violations or. deficiencies. were noted during this. visit. You.will receive no further,
correspondence about this visit'.
vN WW -4)a f71.1,ce) IA)
56*�
s I-Z e- l/-V f'x 17, v,. ll;L
GO Ue,3 kil l 6.5 Ii-
7/25/97

Revised January 22, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number - Operation is flagged for a wettable
Farm Name: (!ar acre determination due to failure of
On -Site Representative: ,4-J-�}�t, Part it eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name: Ite, h Operation not required to secure WA
ll� determination at this time based on
Date of site visit: V I �2 z-� �S exemption E1 E2 E3 E4
Date of most recent WUP:.Val Annual farm PAN deficit: -I— pounds
Irrigation System(s) - circle #: 1. hard -hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; """7. stationary gun system w/portable pipe
C�Gh� Y t U V k r
PART 1. WA Determination Exemptions (Elig ility fai re, Part II, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an 1 or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
Z vi7`� I or Ihm k
E4 75% rule exemption as veri ied in Part Ill. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part Ill).
PART H. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F1 Lack of acreage which resulted in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III.

413 Division ) and Water+Conservation .Operation Review -} 2 ° r#
,0 DiAdon of Soil and Water Conservations Compliance Inspection r r , € �: , £ ,} PR'f lr�
2 y' i I tVlsibmof Water QUAlltj�i� rCorr►plhmce xiR '0 cticih
E< ' �__ .., tintRar.. -'BI E ft iOter;lgenc O�peaow
outine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-u of DSWC review 0 Other
y..
F>Wt.IrNumber Date of Inspection
Time of Inspection D 24 hr. (hh:mm)
Permitted 0 Certified 0 Conditionally Certified [:1 Registered 10 Not Operational I Date Last Operated:
Farm Name: "..! (� f.� ....... jz............... ...�- County: �17 � � ��^�.......................................
.........................................
Owner Name: /;3^y I......
./SPhone No: Y � ` � l)
FacilityContact:`..?........4i..'�.....................Title:................................................................ Phone No:...................................................
Mailing Address: .....1...... q......... ........Z...Y..Q..... V" t/..............................................
Onsite Representative: ....(v........................................................................................... Integrator:...lr.!`TV.,I• d ll.....`s..............,.............................
Certified Operator: ............................................ n,,,, .. Operator Certification Number:
Location of Farm:
..................................................................... .............. ...... .................
Latitude Longitude �• �� 0+�
1' ,Design Current' Design, Cu'"' Design Current
Swine, Ca acity Po ulation `Poultry ..r Ca acit . Population Cattle Capacity Population ,
❑ Wean to Feeder
❑ Feeder to Finish
❑ F to Wean
arrow to Feeder
V
❑ Farrow to Finish
❑ Gilts,
❑ Boars
El Layer
.`
❑Dairy
t.
❑ Non -Layer
❑ Non -Dairy
❑ Other
€ € °' E€
Design Capactfy
j
,.
. .,, ,
Total SSLW
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes o
b, If discharge is observed, did it reach Water ol'the State'? (If yes, notify DWQ) []Yes ;�No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes o
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes d No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �3'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ........... .....r..........................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes .0 No
seepage, etc.)
3/23/99 Continued on back

5:
Facility Number: 6 — Zj— Dale of Inspection
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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I. Is there evidence of over application? []Excessive Ponding []PAN
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, Freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N-6 yW.a iEQris'o cl f e�eacies mere noted il><rritng �hiis'visit: Yoir will ee�iiye 4 fu�thgr.. .
corresnoric�enee. aboutt thus visit.
❑ Yes No
❑ Yes ��No
❑ Yes
❑ Yes
❑ Yes No
ElYes Y o
❑ Yes ,B No
❑ Yes
❑ Yes N
❑ Yes N
❑ Yes N
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes N
❑ Yes o
❑ Yes
❑ Yes
❑ Yes
❑ Yes No
3/23/99

,_.
Facility Number: — z 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 es ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes -No
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o ,
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 o
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
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 n
itiona omments an or rawin s t a �
,
l
s
7
3/23/99

[] D Q Animal Feedlot ` OperatEon ,A6Viiew # .�
Y•`y
11VQ }' AnImal `Feedlot Operation` Stte .� Inspection
c,?
e- -, '.rysx•a ..x'r �.». •v �,,. v �+�. :5, --..-)�`� s -...P '4° 'ff". s„� �2�-
.k
�FacilityNUIllber' Z� Date of .InspectionY Time of Inspection
.42
y - Use 24: hr. time
�P Q
Farm Status: " z 05 ��"`rJE31Toutine ©Complaint [3Fallow-u
Farm Name:(.."c!.dICS14��t�- 3� »_... M ..._ County:�!'.f.� -.1?�....... ..�........ ..........
_
�9ooir ,�, ire.
Owner Name: �m�6Y(=,pl c� Grr�(1 ..._.. .. ... ..._ ... Phone No: �>oq..W.?y .Z/ n %. _....__...._
Mailing Address:
Onsite representative: l%��'.C...%Y.!_.5 _....... Integrator: ..,4/Yrults
Certified Operator Name: � � ... �1�.� . t........................
r_..._..._.....__...._ ...... �...._ ...
Location of Farm: s rZ / j 6.
_.... ................... ......... ....._._....... _....... __............. ...... ....._ .... ..... ......_......_...... ............-...... ................ _........ __.... ._...... ......... ............ .........
........... �+
Latitude 0 41 Longitude • 4 49
10 Not Operational Date Last Operated: _....__............. _ .... ...... ....._...._ .... ................... ,..........-....... ......... .........
Type of Operation and Design Capacity
.�W#ne a it a w DU y: ::' Y 'a, =..
mom;. , Numl�er,� Itr- s;�� N6iW6 �Catt[e w. Number
Wean to Feeder Laver Dair
❑ Feeder to Finish Non-Laver1 Beef
0 Farrow to Wean
?r� r _s:t^�
AaZrnw t ,:x:`5zx. "� :e�§i t„E§��e. z�..:£x,: s »:•fix,.'.'.'
arrFeedpr
ow to Finish 13 Other Type of Livestock,4.6�tea' 3
use)- F-� '-ra4...-_ c�-mr :;'°°°•rw'"'m SiAr .,,.*aa"�,. x'" i:, „°`r 3%- '„
?} Zl7,'�x..7F�-Y 't x�.:5C 'v.�t,5 t:r�- 'a );J.:;:� e.,.. >`X�C,e r: 3i,',�.°:"iaLL;-
�"'a"�'i,[s:x
NusnberofLagoons f Holding�.1'ondS� �_-� � Subsurface Drains Present � �"
�.�'� "�` '"°`� >���Y ,�� � �'�� �p-��_} �� ��� ; ❑Lagoon Area [] Spray Fieid Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes emu., iv�o
2. Is any discharge observed from any part of the operation? ❑ Yes
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWO) ❑ Yes ❑ Na
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? Yes �<�
No
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes.
5. Does any part of the waste management system (other than lagoons/holding ponds) require 'Yes❑ No
maintenance/improvement?
Continued on ,back

8.
Is facility not in compliance with any applicable setback criteria?
❑ Yes
0Na
7.
Did the facility fail to have a certified operator in responsible charge (it inspection after 1/1/97)?
❑ Yes
] No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
4D-!90
Structures _(Lagoons and/or Holding Ponds)
9.
Is structural freeboard less than adequate?
❑ Yes
No
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4
10.
Is seepage observed from any of the structures?
❑ Yes
El No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
!���1
12.
Do any of the structures need maintenance/improvement?
❑ Yes
t� 4
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWO)
13.
Do any of the structures lack adquate markers to identify start and stop pumping levels?
❑ Yes
Waste Application
14.
Is there physical evidence of over application?
es "
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWG) f
15.
type / -
Crop iT ...�' ? ! SAL 4. 1,"_......................................._ .....� .... .........
YP C J..
16.
Do the active crops differ with those designated in the Animal Waste Management Plan? n o P/4"/
❑ Yes❑
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
,
No
18.
Does the cover crop need improvement?
❑ Yes
_
19.
Is there a lack of available irrigation equipment?
El.b Yes
,
No
For Certified Facilities Qnly
IV() PCl9n /)�y aP YG r:
20.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
21.
Does the facility fail to comply with the Animal Waste Management Plan in any way?
❑ Yes
❑ No
22.
Does record keeping need improvement?
❑ Yes
❑ %
23.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
24.
Did Reviewer/inspector fail to discuss reviewlinspection with owner or operator in charge?
❑ Yes
❑ No
1l/0.L►aQW rx�� �s aru&lS;�rNtt�
I�
f. 2:'' t,,, e,/ ; •� r� �j:: t. ��G ri �JC'44, 0
Cn. /..,.... Z
Reviewer/l Spector ` Name
Revewer/Inspector Signature , Date „
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96

' DEN WATER QUALITY SECTION TO
15:26 FROM
P.02/02
y
Time;
Farm Name/Owner:_ W , `f H Ft 2/cf'--
Mailing Address: , 0 _6 0 k y rem !/!4
County. _&yy-f N 4 —
Integrator. _ .. M _ _ — -- _ Phone:
On Site Representative: _ _ _ _ _-- - Phone:
Physical Address/I..ocadon:
RRO
Site Requires Immediate Attendor,
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 — S ! , 1995
Type of Operation: Swine � Poultry Cattle
Design Capacity: — / Zo ° _ Number of Animals on Site; l� of d v o
DEM Certification Number: ACE,___. _ DEM Certification Number: ACNEW� _
Latitude: Longitude: Elevation:
Circle Yes, or No
Does the animal Waste Lagoon have sufficient fTeeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 'fir No Actual Freeboard:[. Inches
Was any seepage observed from the lagoon(s)? Yes o `No Was any erosion observed? *s or No
Is adequate laud available for spray?(IDe or No Is the. cover crop adequate? Gor No
Crop(s) being utilized: M
Does the facility meet SCS minimum setback criteria'? 200 Feet from Dwellin s _ No
100 Feet: from Wells . or Na
_�e anima] waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes a
animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes arQ
animal waste discharged into waters of the state by man-made ditch, flushing system. or ether
iim;lar man -matte devices? Yes or No If Yes, Please Explain.
ra�,c5 u6e facility maintain adequate waste management records (vo umes of ruanure, land applied
spray irrigated on specific acreage with cover crap)?Yes r No
Additional Comments: _ -�"A's _�r� �%'� r4�tM�-✓i,FLi ' ��1 �� G f CgriddtJ
it&- 104✓fr4o 5��� djr 4- -7
4AJ ,H S + 65Aatl ✓ ✓A (- i ^q
b f ,q ✓
Toss-1 r fi b�
Sr) e- w s $a; 1 p'^ i ^ Aela Sh.r1f e SD � Is -� E C. r9 -f��4�,eV 5C s
Signature
cc: Facility Assessment Unit Use Attachments -if Needed -
TOTAL P-02

0.7/05/95 09:24 USDA EDGECOMBE pg. 08
—IGS-fNG-Ma
rt... i.70 SOIL CONSERVATION SERVICG
cnn i1VVKc7Ir:ATinN TO nFTFRMINP 4IIITABILIT`( OF PROPOSED POND SITE
FARMER'S NAME.,,_
DIS'IRIC'i t'r
DATE _ 4 �
-- COUNTY
�` r
S. C. S. PHOTO SilEET NO.
WATERSHED AREA MEASUREMENTS �•
CROPLANA ACRES PASTURE
WOODLAND ACRES TO'TAI.
RES A!QA CLASS WORK UNIt CONSERVATIU:+IST
SKETCA OF PROPOSED D
ING WHERE BORINGS WERE MADE (Approx. stale I"- feet)
ate reference point in [ender line o1 dam and identity on sketch.
i
4i�
t
j
t
E
! r f
Al
I
-
-
I'Yqlf
,
y
j
a
s w[)w i
BORING NUMBER AND PROKU.,
t
j1F..1'Tt�� goAA . ,J L'I 6a,n"dt una ssaifway
bo,inpr ant, then ponded arra and bo­uw pif pnrirrpa • separate u+1th '.rv*c-0i rod 41ne.
' ­vnhhuei nn hark whrre nrtatsoryi
—'
Shaw wifr+ tapir eerurlffunt rn Jam-t.e� hormat.
-
r + <- 5 B
— - •-
B ° ID ' 12 [3 ;� i� IB r ! 7� =BIK Do� 'Li i
lj
tr
s "—�}—
I } h � G' i•o �! it
��J'�E�ii�lr.' �, II', ilIRINNI (l �4l♦I l��l �i�►rW= �m}f
BORINGS MADE 9IGNATITRF. & TI'?Z.E'__._

V/05i95 09:25 USDA EDGECOMBE Pg. 09
(Use one or systems oeiow)
UNIFIED CLASSIFICATION USDA CLASSIFICATION
!W - Well graded gravels; gravel, sand mix g- gravel
-P-Poorly graded gravels s - sand
yl-Silty gravels; gravel -sand -silt mix vfs-very fine sand
C-Claycy gravels: S^nn4v loam
-►kel1 gea-� a; sand-� sr+ndv loam
P -Poorly graded sands
M - Silty sand gl-1gravelly loam
C-Cl2vey sands: sand -clay mixtures si-silt
:L si its; sil;v, v. tine sands; sandy orclayey silt si! 'silt !oars
I_ c:joys of low to medium plasticity-1-Clay loom
li - inorga:tic clays of high plasticity siclll- silty clay loam
P - FlnMic silts scl -sandy clay loam
C-Organic silts and silty clays, low Plasticity sic - silty clay
ill -Organic clays, medium to high plasticity c -clay
1. Suitable material for embank ent is available r7ye0 I No 11-dir.0towhe'd rowrra .1ktiek eA
wm"w aids) i
REMARKS: 5 /'/n1 / r
U'-� y Av t n4 J O
2. Explain harards requiring -: ,r�r.�:ion in deaigc rs,.>�., ��-/ut.. -ecc-,
Cc �c;irf Sc�nd u.:1[�di i� it /0/uC`t7C an?S
r5�' ,
;F:.*tF:lt1L1. it1:MARK.+: _
i
l a )_ cl
26
27
28
9
30
34'�
33
i1
39 40
43
42 L7 44
,
48
4t
a?�I t&
l 50 i�f2b
4g
-tJ—
_µ—i_
14[
I � -�— •'�
II
I
ff
i �
I it li
-
+ii
q
..._,; _ _.
.._.4.__..._;
4 - k -u _.. u. .4 4..u--

*A
F• '
w EDSWC Animal Feedlot Operation Review w_x
`�, ❑ DWQ Animal Feedlot Operation Site Inspection
Routine 0 Com taint 0 Follow•-u of DVVQ ins ection 0 Follow-u of DSx C reyic%v 0 Other
LE.aic6i�li�tyNumber :
Date of lnspcction
Time of Inspection 24 hr. (hh:mm)
Total Tirne fin fraction of boors
Farm Status: ❑ Registered ❑ Applied for Permit lex. 1.25 for I hr 15 min)) Spent on Review'
❑ Certified ❑ Permitted or Inspection (includes travel and processing)
10 Not Operational Date Last Operated: ................................................................................................................................................
Farm Name:.tt m 3 County: .......................
OwnerName: ................................................... ........................................................................ Phone No:......................................................,..........,.....................
Facility Contact: ................. ............ 'Title:.................. .. Phone No:
I9ailing Address: ....................................4�,&
................................... ... I ...... ............ .......
Onsite Re resentative• p`.,,�.1�-.U��....!..,:,.:�....... ...JrUGEeV..j.... Integrator: ......................................................................................
Certified Operator:.... ............................. .. Operator Certification Number:..,.,............,
Location of Farm:
Latitude • 1 :° Longitude • �� �.4
Type of Operation Design Current ' Design Current Design Current
Swine ,. Capacity: Population.•,. Poultry Capacity Population Cattle Capacity,. Population ,.,
I
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean
TI.T.3
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Number of Lagoons / Holding P 10 Subsurface Drains Present ❑Lagoon Area JE1 Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any dischan�e observed from any part of the operation'?
Discharge originated at: ❑ Lagoon ❑ Spray Field El Other
a. If discharge is ohscrved, was the conveyance man-made"
b. If discharge is observed; did it reach Surface: Water? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5, Does any part of the waste management system (other than lagoons/holding ponds) require
4/1 0197 maintenance/improvement?
❑ Yes WNo
❑ Yes 6 No
❑ Yes FINo
❑Yes d1110
❑ Yes ONo
❑ Yes ;�No
❑ Yes] No
❑ Yeti No

Facility Number: —
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[/No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
yNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
VNo
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
�/
[ No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
1... ............. I .......... I.. ..... ............................ ........... ........ ................ ....................................... .... .............................
10. Is seepage observed from any of the structures?
I .... ....... I ..................
❑ Yes
.......
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
/❑
12. Do any of the structures need maintenance/improvement?
P'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
[dNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
E�No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) `
15. Crop type ..�1. ...../................................................................................................................................................................
...........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
eNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
A No
18. Does the receiving crop need improvement? Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes PNo
20. Does facility require a follow-up visit by same agency? ❑ Yes eNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ZNo
For Cerlitied Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes Z No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �dNo
24. Does record keeping need improvement? ❑ Yes ❑Alo
); ' . U C G-G Pr- r't /J a f i-/i _06r /v
Reviewer/Inspector Name I$✓ a .� �ao-2- <' 3! `. ...2
Reviewer/Inspector Signature: Date:
cc: Divisinn of Water nuality_ Water f1uaT Certinn_ Fardily Asse.ssmeltt Unit 4/30/97

•f.w - '�ii: .r.-.J'�F �=vF=.:•" -:fir`TS:T4'"cr.�-++rrry..,-.-..rrr...v�PtY`V��fifq},'�4�... �, w;yror wrrlar.�i`•,-1. �s i. :r.�•T�i`,d"` "'�w ,_ .... � :-�.T a ,.. - _ _ .� ..fi__.-..-,�.- : -.,
6 k E. WCAnimalFeedlot Operation Reviewh�
`' �,'�. �❑ DWQ Animal Feedlot Operation Site Inspection"04"�
z
I( -Routine O Com faint 0 Follow-u p of [AV i inspection 0 Follo,-%r- up of DSIVC; review lul
Date of luspection
EFatility NumberCZ==
Time ofinspection - OS 24 hr. (hh:mm)
Total Time (in fraction cat' hours
Farm Status: ❑ Registered ❑ Applied for Permit fex: L25 for l hr H min)) Spent on Review
or Inspection (includes travel and processing)
0C 'rtltied ®Permitted
© Not Operational Date Last Operated: ...................................................................AV
...................%.........................................................
Farm Name: i�f.Gr�t o Z% �' 3 2. County: i�..�:L.�jl�l��c.................
...............................................................................................
Owner Name:...... .rf..>I^......... ?. o .r...................l1g1 ................ Phone No: ......,.
Facility Contact: ........ .....
........................... ........ .f ......�PhoneNo:,G�........................................... Y Z%G
i9.
M. AP .QY/Z �-0W�aJ�z-, ? 70
............ .......................... .................r.......�.....................`............... .,...............
Onsite Representative: ........... ............... �/�...rc� .........,.,......,.......... Integrator: (x.KfAls .............................................
Certified Operator: ...........
1, .............. '. !......
�] ( ......... Operator Certification Number:....�8s. ��
........... ...........................
Location of farm:
....
...........'.... ..............,.......,.,...............,...........................,.......,.,................................................... ............ ............. H
r, ,r - 181-00.
Type of Operation Design : Current Design Current Design Current
.: Swine Capacity' Population Poultry Capacity Poptlation Cattle,,- Capacity Pupu.Iation
❑ Wean to Feeder
❑ Feeder to Finish
0grow to Wean
/Zro
17
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
Total Design Capacity q vG.G 9 9
Total SSLW 3 626400 16s.
Number' of Lago6ns"1 Holding:. on so ❑ SuhsurFtce Drains Present ❑ lagoon Area JEI Spray Field Area
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
it. If discharge is observed, was the conveyance ratan -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?
1
cf. Does discharge bypass a lagoon system" -(If ves, notify DWQ)
1
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 it discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
413 Uly 7
maintenance/improvement?
❑ Yes U<o
❑ Yes 10"&o
❑ Yes ❑ No
❑ Yes ❑ No
0-
❑ Yes
❑ No
❑ Yes
9'1C0
❑ Yes
❑'No
El Yes
❑Q<o U
Continued an hack

.�..., ,: .--. . .,..-. ..:.-_s^rro �^v_.:-...a..-,.--..vv.... v,Tq. .r .w,.q'.a ri •.ar v.-.
"'qR�•,�'- % it C"'y' >ti;4e�rv�:r. x �-�y„h••s�^.. ;,,,. ..., �.wrxrr'""'-•i."e r•T.2swm_. �'r.r.9'-, _. yS'C!'.`µ.�n',�,�3.5,�' ..
Facility Number: - Z
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [+.} <o
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 0-16
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes allo
Structures (La goons and/or Holding Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Pl<o
ti.
.y
Freeboard (ft): Structure I Structure 2 Structure 3 Sttucture 4 Structure 5 Structure 6
............. 11.1................................................................................................................................ ...................................................
rr
10. Is seepage observed from any of the structures? r C, 5 - ❑Yes [B'lqo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes o
/. 7.5-
12.
Do any of the structures need maintenance/improvement?
❑ Yes
LffNo
(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 g�- o
Waste Application
14.
Is there physical evidence of over application? 1
❑ Yes
B-i o
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .......C..O;". �...... S�.r �`s''.................................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
][' 00
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
��
Cg-<o
18.
Does the receiving crop need improvement?
❑ Yes
I-lo
19.
Is there a lack of available waste application equipment?
❑ Yes
[II-N6
20.
Does facility require a follow-up visit by same agency?
❑ Yes
aN6
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EKO
For Certified Facilities Only ,�,
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ElYes f <0
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes B-N'O
24. Does record keeping need improvement? ❑ Yes E'No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 6/12/ j
4/30/97
cc: Division of Water Quality, Water Quality. Section, Facility Assessment Unit ' r

State of North Carolina
Department of Environment,
Health and Natural Resources
Raleigh Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
1DEEHNFZ
DIVISION OF WATER QUALITY
July 15, 1997
Mr. Rudy Grammer
Smithfield Carroll's
P.O. Box 1240
Waverly, Virginia 23890
Subject: Compliance Evaluation Inspection
Facility # 66-22
Carroll's Farm 32
Northampton County
Dear Mr. Grammer:
On July 8, 1997, Mr. Buster Towell from the Raleigh Regional Office
conducted a compliance inspection of the subject animal facility.
The inspection is part of the Division's efforts to determine
compliance with the State's animal waste nondischarge rules.
The inspection determined that the operation was not discharging
wastewater into waters of the State and that operations were
proceeding according to your approved Animal Waste Management Plan.
As a result of the inspection, the facility was found to be in
compliance with the State's animal nondischarge regulations.
Effective wastewater treatment and facility maintenance are an
important responsibility of all animal waste producers. The
Division of Water Quality has the responsibility to enforce water
quality regulations in order to protect the natural resources of
the State,
The Raleigh Regional Office appreciates, your cooperation and
compliance. If you have any questions regarding this inspection
please call Mr. Buster Towell at [phone].
SincerelyA
J y Garrett,,
Water Quality Section Supervisor
cc: Northampton County Health Department
Mr. Tony Short, Northampton Soil and Water
Conservation District
Ms. Margaret O'Keefe, DSWC-RRO
DWQ Compliance Group
RRO Files
3800 Barrett Drive, Suite 101, ' FAX [phone] S
Raleigh, North Carolina 27609
N%q ff C An Equal Opportunity Affirmative Action Employer
Voice 919-571-4700 50% recycled/101% post -consumer paper

i
O Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection
Z2
Time of Inspection O t) 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ 3a Bred ❑ Applied for Permit (ex:L25 for 1 hr 15 min)) Spent on Review ,SD
O'Cer[ified ❑ Permitted I or Inspection (includes travel and processing)
/❑ Not Operational Date Last Operated: ............................... . ................................................................................................. . .................
Farm Name: f rfiY,C e..11 g ............7........................................................_......, County:.Zljp: a�19/`•_f� �...... _...... ....................
Land Owner Nam�e7...../,v�5............................................................................ Phone No:.. .Q.�%..--P.��?l 4. ....... �10.2.....................
Facility Conctact: 1 kt,y..Jpf.'t!� h- ........................... Title:
Phone No:.... ..........................
Mailing Address:.V .:: b °..i�...ly.�(U GVoI.� a-l. (A a2. 31.11._................................................
...........
Onsite Representative: Ln~u .... LI 5.........-........................................... Integrator:..4�7Y/'✓�� �.............................:.....................
Certified Operator:....4.t'.1/.. r!......!'..........................................._..........., Operator Certification Number:
Location of Farm: S
_................................................................................................................................................................................................................................................._ 4
... rs
Latitude 0'0`0" Longitude 000 �«
Type of Operation and Design Capacity
Wean
Other
Subsurface Drains
Lagoon Area
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 gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
Field Area
❑ Yes �N00
El Yes ; 0
❑ Yes Z Nyi
ElYes , No
❑ Yes
❑ Yes No
El Yes Io
El Yes 49
Continued on back

6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7: Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Strughires (Laggons and/or Holding :Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
y..r
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes 1Q No
❑ Yes P.O
❑ Yes 2<0
❑ Yes ldNo
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type l%'".4tnr-.........................................I.....................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certfifled Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
El Yeso
.........N
❑ Yes
❑ Yes�Zo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes .l�J N
❑ Yes L N f
El Yes No
❑ Yes ,_ NNoo
❑ Yes 1'N0
❑ Yes ! o
Reviewer/Inspector Namer:.
Reviewer/Inspector Signature: _ Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

W/05/'95 09:25
USDA EDGECOMBE
Pg. 09
(use! one at
UNIFIED CLASSIFICATION
M-Wel', graded gravels; gravel, sand mix
•P-Poorly graded grovels
..M-Silty gravels; gravel -sand -silt mix
C -Clayey gravels:
'X -Belt g7a - L ! ssnd-�L.
P-Pootly graded sands
M-Silty sand
C.Clavey sands: sand -clay mixtures
.'L Silts; silty, w. fine sands; sandy Orcl­OM silt
t. (_1s's of "Ovd to medium plasticity
H • Inorganic clays of high plasticity
P - Elastic Silts
OL-Organic silts and silty clays, low plasticity
41 -Organic clays, medium to high plasticity
Delow)
USDA CLASSIFICATION
&- gravel
5 -,sand
vfs-very fine sand
I, T: niily !OaM
sandy loom
gl-lgrovelly loam
'j - ralt
S." 11 is i It !0em
Ci - Tky loom
sic], -silty clay loam
scl -sandy clay loom
sic -jsilty clay
c -C�Hy
I
1, Suitable material for embankment is available OYeit rX NO jjn&Ir where IoWfra on th, 54,101. 0"
rarer ilia)
2, Explain bamrda requiriuv t-;- ration in desiet fi-nMot, raCA Or—
Y
-JV2N1jtAL REMARKS:
­71 - _serpo,c
MMMMMM
MEMIM
113
11101013
JBM
W
HOMERS
MIMIMIMIMIM
IMUNIMI
Rim

-07/05,/95 09:24 USDA EDGECOMBE pg. 08
scs-fr,G-s3•
.... s �o SOIL CONSERVATION SEwout -
cnn %NVVrTt(:ATlnN TO I]FTERMINE SUITABILITY OF PROPOSED POND SITE
i
• •
CROPLAND-•.. r
•
WOODI-kND- ACRES TOTAL -..NON 4
c
SKETcrf OF PROPOSED •s :a• •• feetIll l
-
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■■■�■
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mom
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wmm
mp"MommosommmoBin!!�
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ommom■■■
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i
�- - Anr
`µ

'l3
0 Divi ' f Soil and Water Conservation ❑ Other Agency
ivision of Water Quality
0 Routine 0 Complaint 0 Follow-up of DW( ins txtion 0 Follow-uE of DSWC review 0 Other
Date of Inspection WiMl
Facility Number Z 2—
Time of Inspection b3 24 hr. (hh:mm)
13Registered [3Certified D Applied for Permit 'ermitted 0 Not O erational Date Last Operated:
Farm Name ......:%..... ...I.. r.. /T!h—:... 2—County: , l�! f1 ✓ �T i�f4... ........................
Owner Name:............. r.!'!' �..f i—D rjj Phone No:,,;? ... �.Y., Zl...0. (.........................
Facility Contact:.. .(..vi L
........................`.....,.,................ Title: Phone No: ...................................................
Mailing Address-....,, ....�.0... ......�..z�%..0... �� ve v- ...... -3 ../. i................................................ ..........................
Onsite Re resentative:..../!^��
�.......................... Integrator:...................................................................................... -
Certified Operator___, j-,,.'t ... Operator Certification Number, .........................................
Location of Farm:
0
'o
Latitude ` =' 66 Longitude =• =, 44
Design Currents
k DestgitCarrent' Design£ Current
Population
Poultry 5 „Capacity Populat�oa Cattle, Ca act Po ulatinn
MhSwmeCapac><ty
n to Feeder
❑Layer` ❑ Dairy
ffOFeed er to Finish
❑ Non Layer Non Dairy
F�_s F�.�
IV&❑
S �
w to Wean
❑ Other �s
OT arrow to Feeder
or
e_
r g Total Design; - acity:n' `
Farrow to Finish
�
.n : 0
❑ Gilts,
°� ' �motal
1
Boars
q iai. V, G`
Number 'agoon HoldtnPonds n g
g g� Subsurface Drains Present ❑ La oon Ares
Spray
❑ 5 ra Field Area
.' F r ❑ No Liquid Waste Management System��
,,
ci , A .:i Pc REF k x..it it
3�
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)
e. If discharge is observed, what is the estimated flaw in gal/min?
cl. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not 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?
7/25197
❑ Yes Cols
❑ Yes o
❑ Yes T 0
❑ Yes o
❑ Yes No
❑ Yes o
❑ Yes
❑ Yes o
❑ Yes
❑ Yes No
Continued on back

• Fj al5ity bomber: 1� 0-4 (S t:;qe_t_ 3Z._
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (L.agoons.Ifoidine Ponds, Flush Fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 structure 5
Identifier:
freeboard (ft): q7,rf ......................
10. is seepage observed from any of the structures'?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12., Do any of the structures need maintenance/inipi-ovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type r �....... f.............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19, Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/]nspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25, Were any additional problems noted which cause noncompliance of the' Permit"
0 No.violations or deficiencies were noted during this.visit.- Yon will receive'no further
correspondence alioijt this.visit:
❑ Yes s °a
❑ Yes C15o
Structure 6
❑ Yes o
❑ Yes El do
❑ Yes is<o
❑ Yes i o
© Yes
❑ Yes No
❑ Yes 0 No -..
❑ Yes' )No I
r'
❑ Yes +Na
❑ Yes o
❑ Yes - I``o
cs ❑ No
❑ Yes B No
❑ Yes fl'No
o
.❑ Yes
Comments:{'refer to'.question #) ,Explain any 1c"1;5 answers and/or'any recomsnendatEons or any tither comments:�.
Use drawings of facility to'better explain situations (ust additional pages as nete5sary) .f r
.;,.�
l2��►- d •i rL s u /2_2 - Z CcoYl,�ff 5 4 o ,.I
7i25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �'�j,�,y, G6IZ41 'v Date:

Division of Soil and Water Conservation - Operation Review
Division of Soil and Water Conservation - Compliance Inspection
13 Divisioa of Water Quality - Compliance Inspection
CI
Other Agency - Operation Review
iQ Routine O Complaint Q Follow-up of DW2 inspection !R Follow-up of DSIVC review Q Other �
Facility Number �.� Date of Inspec-ticin
-_- - -,- .1 Time or 1nst)ecb(m 24 hr. (hh:mm)
0 Permitted © Certified © Conditionally Certified [3 Registered Not O )'rational Date Last Operated:
Farm Name. County ............
OwnerName:........................................................................................................................... Phone No:.......................................................................................
1acility Contact:...............................................................................Citle:................. .. Phone No:
-failing address: r �* , ..........................
Onsite Representative:.../?.. ....... 1%`(L.f .l'i..r1............................................ Integrator:....,.......................,.........................................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude �•�' Longitude �w
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 10 Laver I❑ Dairy
❑ Feeder to Finish JCI Non -Laver ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
{ Number of Lagoons EI I Lj Subsurracc Drains Present JJU Lagoon Area Jl ] Spray Field Area
II Holding Ponds I Solid Traps JE3 No a.irtuid Waste :Management System
Discharges & Siream Ialpac:t_s
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. ]!' discharge is observed, was the comgo ance rnan-made?
h. If discharge is observed, did it rrreh Water of the Slate? (11'yes, notify DWQ)
c. If discharge is observed. ~chat is the esiiin:tied tlou- in ,alhnin?
d. Does discharge hypass a lairoon system' (II' yeti, nori!_Y 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 ti Treatment
4. Is storage capacity (freeboard plus storm storage) less than adccluatc? [I Spillway
Slrticlurc I Structure ? Struciurc3 SIrUClUrc 4 Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes [] No
❑ Yes (:]No
❑ Yes ❑ No
❑ Yes fZJ No
SIRIctUl
Idcntif�ier: ,
i
I-'rreboard (inches): .................................................................................................................................................................................................................
5. Are there any inuneditate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [) Yes ❑ No
y " y seepage, etc.)
3/23/99 �� 1 ,r�� mot/ a rm /� `� 1' ; L. y� t Continued on back

State of North Carolina
Department of Environment,
Health and Natural Resources
Raleigh Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
AT? �
DEHNR
DIVISION OF WATER QUALITY
July 15, 1997
Mr. Rudy Grammer
Smithfield Carroll's
P.O. Box 1240
Waverly, Virginia 23890
Subject: Compliance Evaluation Inspection
Facility # 56-22
Carroll's Farm 32
Northampton County
Dear Mr. Grammer:
On July 8, 1997, Mr. Buster Towell from the Raleigh Regional Office
conducted a compliance inspection of the subject animal facility.
The inspection is part of the Division's efforts to determine
compliance with the State's animal waste nondischarge rules.
The inspection determined that the operation was not discharging
wastewater into waters of the State and that operations were
proceeding according to your approved Animal Waste Management Plan.
As a result of the inspection, the facility was found .to be in
compliance with the State's animal nondischarge regulations.
Effective wastewater treatment and facility maintenance are an
important responsibility of all animal waste producers. The
Division of Water Quality has the responsibility to enforce water
quality regulations in order to protect the natural resources of
the State.
The Raleigh Regional Office appreciates, your cooperation and
compliance. If you have any questions regarding this inspection
please call Mr. Buster Towell at [phone].
Sincerel�
C"
m-,a
J y Garrett,
Water Quality Section Supervisor
cc: Northampton County Health Department
Mr. Tony Short, Northampton Soil and Water
Conservation District
Ms. Margaret O'Keefe, DSWC-RRO
DWQ Compliance. Group
RRO Files
3800 Barrett Drive, Suite 101, FAX [phone]
Raleigh, North Carolina 27609 Ni 4F C An Equal Opportunity Affirmative Action Employer
Voice 919-571-4700 50% recycled/10% post -consumer paper