310130_INSPECTIONS_20171231

NOHTH CAHOLINA
Department of Environmental Qual

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Techn
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other
Date of Visit: Arrival Time: Departure Time: / County:
Farm Name: (� �rrY 1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 4
Title:
U Onsite Representative: �i�tlti Lv-
Certified Operator:
Back-up Operator:
Phone:
0 Denied Access
inn Region:
Phone:
Integrator: Q
Certification Number: 2- r
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
C*urrent
Pop.
Design Current
Wet Poultry C►apacity Pop.
La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
[Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , l;ou1. Ca aci P,o
Layers
Non -Layers
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
t
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes No ❑ NA ❑ NE
[]Yes ❑ No
❑ Yes [—]No
❑NA ❑NE
❑ NA ❑ NE
[::]Yes ❑.No ❑ NA ❑ NE
❑ Yes T ❑ NA ❑ NE
Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: Gt
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 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 [DNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
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 6No ❑ NA ❑ NE
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
1, To
❑ NA
❑ NE
❑ Yes
❑rN
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
io
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� o ❑ 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 To NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes To ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

I
Facili Number: - (10--i Date of Inspection:Zi
24. Did tht facility fail to calibrate waste application equipment as required by the permit? ]Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ Na NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes d N� ❑ NA ❑ NE
❑Yes YNo
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any.other comments.,
Us��wings of facility to better explain situations (use additional pages as necessary).
�Y �-S, r� tom
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
f` D .�-el . Phone: (0 ? 9 6 _3
l' Date: & 12 117
21412015

Type of Visit: 40 Corn Hance inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
sit: L o Reason for Viutinc 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 4, (;, Arrival Time: 2oj Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:'
Title:
Onsite Representative: v AT A►•MIULPL
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Curret�
w. Design .Current
Swine
Capacity Pop.
Wet'Poulfry
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
Farrow to Wean
Design
C►arrant
Dry Cow
Farrow to Feeder
D , P.oultrp
Ca acit
Pao ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other_,Turkey
Poults
Other
10ther
Discharges and Stream Impacts
I. is any discharge observed from any part of the operation? [:]Yes �o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes VNo
NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

acility Number: - Date of Inspection: 010
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1f,
Identifier: A6(,)'
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): _?
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 Io ❑ 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 DWR
7. Do any of the structures need maintenance or improvement? [2/Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes O<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 [2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Apptication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes d No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes rNNo ❑ 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
ONO
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ef'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EJ'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
eNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FNo
❑ 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 [D<0 ❑ 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 L2<9 ❑ 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

acili Number: - Date of Inspection: (p
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
allo ❑ 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:
i
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?
❑ YesE�<o
❑ NA ❑ NE
Other Issues
,28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
EZNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[] ❑ 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
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?
Reviewer/Inspector Signature:
Page 3 of 3
[—]Yes PAo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes 6 No
❑ Yes No
❑ Yes ZNO
Date
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
�g1 I ►U
214120I5

(Type of Visit: (5rCom ' nee Inspection V Operation Review O Structure Evaluation (-) Technical Assistance . I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Jj
Date of Visit: p Arrival Time: Departure Time: 9 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: S cO f Or J_
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry C►apacity Pop.
Layer
Cattle
Dairy Cow
Design Current
C►►apacity Pop.
Wean to Feeder
Non -La er I
Dairy Calf
feeder to Finish
Farrow to Wean
Design Current
Dry P,ouEtr, Ca aci P,o P.
Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3 N
❑ Yes En No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes E �"O NA ❑ NE
❑ Yes to � NA ❑ NE
21412015 Continued

Facili Number: - I —� Date of Ins ection: ,
Waste Collection & Treatment _
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0' ❑ 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): I
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 Ej"No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No D NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ea -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 El"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6] No ❑ NA ❑ NE
maintenance or im rovement?
p
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ETNO. ❑ 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?
❑ Yes [fNo ❑ NA ❑ NE
[—]Yes ["No [DNA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available? Yes ❑ N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes u No ❑ NA ❑ NE
the appropriate box.
❑ WUL' ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other-
2 1. Does record keeping need improvement? If yes, check the appropriate box below. �/ 1'es 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 To ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: 77L
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[El 1V o .
❑ NA ❑ NE
02�5_s the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Lt:�` 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?
es
❑ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
E3-*NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E3-'&o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �o ❑ 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 go ❑ 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
0NNo
❑ 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
ErNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Reviewerllnspector Signatm
Page 3 of 3
v i
21412015

- ivis"ion of Water Quality
Facility Number - !3C��IYAWWon of Soil and Water Conservation
O Other Agent y
Type of Visit: oinpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: .E!rfioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: It #Arrival Time: parture Time: County: �itRegion:
Farm Name: `?` Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title: Phone:
Latitude:
Integrator: ;-;I
Certification Number: �� y
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Cattle
Dai Cow
Design Current
Capacity Pop.
Wean to Feeder
HNon
±ae
a er
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
D , P,oul_ C_a aci P,o ,
ILayers
Non -Layer
D Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 E2 &o ❑ NA ❑ NE
❑ Yes JZNo
[:]Yes ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes V'No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
Page I of 3
21412011 Continued
ct

Facility Number: - b Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4 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 VNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;2rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1;tNo ❑ NA ❑ NE
maintenance or improvement? T
Waste Anulication
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes �o ❑ NA ❑ NE
maintenance or improvement? TT
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, et .
❑ 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 X No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E2f*4o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �To ❑ NA ❑ NE
acres determination? TT
17. Does the facility lack adequate acreage for land application?
❑ Yes wi No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes j"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes -EY-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yesk E?N'10"
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes [�10
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [3*'<o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection:
i5
_2-4. Did -the facility fail to calibrate waste application equipment as required by the permi . ❑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 to provide documentation of an actively certified operator in charge?
❑ Yes
9No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ .Yes,,
VNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ONo
❑ 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
2fNo
❑ 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
ZNo
❑ 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
4No
❑ 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 napes as necessary).
S/1n�- 5erCv1 +'-r { f d
7)1--,? 4 _5— /7
t r rt�
s
aeJ 0666 `-
9
f
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: �T
Date:
21112011

Type of Visit: Q Co pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r3 Arrival Time: Departure Time: County: bt,PL.'/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: S Coy t- 9 r,-- r j r Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: ��
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design rrent
Wet Poultry Capacity CuPop. Cattle
Layer Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dairy Heifer
Design Current Dry Cow
D . P,oult , Ca aci P,o Non -Dairy
Layers Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ o ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili dumber: -13ED Date of Inspection: 10
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2
Identifier: l.lA(ro o►J
Spillway?:
Designed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): _ 1�
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.)
/No
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ YesrNo
❑ 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 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0 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
❑ 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 No
❑ NA
❑ NE
acres determination?
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
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WIT ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ' ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility dumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑Yes t=JZo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes l� ❑ 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 [2/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 4o ❑ 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
[f 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
0_Nc
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EKo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ej/No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or -any other comments
Use drawings of facility to better explain situations (use additional pages as.necessary
Reviewer/Inspector Name: % a -Vic -, Phone(
Reviewer/Inspector Signature: Date: 7-
Page 3 of 3 2/4 011

Type of Visit: Q�70utine
ance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance v
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O Departure Time: D County: )LfflRegion:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �jQ d,L\ 1(,[ eft Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
l4-1W
Design Current
Swine Capacity Pop.
Wean to Finish
Design @urrent
Wet Poultry Capacity Pop.
ILayer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
I iNon-Layer I
Daia Calf
14
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ENDesign r e
D , P,auI Ca aci_ P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ NA ❑ NE
❑ YesYNo ❑ NA ❑ NE
Yes 0 [] NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: G2 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes do ❑ 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: -6Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): M
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.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment
threat, notify 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
Wo ❑ 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 To ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes tn No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 ❑ 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fait 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 ❑ 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
Qo ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
a. 0 ❑ NA
0 NE
Page 2 of 3
21412011 Continued

Facili Number: it - 0 Date of inspection: 7/5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes a<101z ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes EDAo ❑ 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
[ l`o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
UN110,
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Cl/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 E] 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 Mo ❑ NA ❑ NE
❑ 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
❑ Yes
❑ Yes
EjNo ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
iComments (refer to question ft Explain any YES answers and/or any, additional recommendations or.any other comments
use,drawings of facility to better explain situations (use additional.pages:as necessary);'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �%
a -pie Date:
2X4/2 JII

Type of Visit: Q'Co ance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
isit Reason for V�Rouutine 0 Complaint 0 Follow-up 0_ Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I s� jT i I Arrival Time: Departure Time: County: "U3X) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 0 e "�� lM �.-� Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish Layer
11
Cattle
Dairy Cow
Design Current
C►apacity Pop.
Wean to Feeder
INon-Layer I
Dairy Calf
Feeder to Finish MEE6
Farrow to Wean
Design Current
DrF P,oultry Ca acit P■o P.
Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 0NNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [] o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

[Facility Number: - d Date of Inspection: g ht
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: &ZtrJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `% K
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ca"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 Ko ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [—]Yes ENo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 1Vo ❑ 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 ff�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [3 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 El"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 ❑ Yes644'o ❑ 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 No
❑ Yes / No
❑ Yes [ "'o
[:]Yes D190
❑Other:
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q o ❑ 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 Inspecti;'No/
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 To ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3 1.- 13C7 Date of Inspection: �
24 Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E34 ' ❑ 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
CTNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
.4<6­ ❑ 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
0 Yes
�No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
l.D- ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[lo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
io ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.h;;. ;
Use drawings of facility to better explain situations (use additional pages as necessary).
,»
Reviewer/Inspector Name:
rr
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412011

Facdlity Number . _ Q
Division of Water Qualit;
0 Dmsi©n ofSoil and ;Wale
_:0 Other�Agency �°='��
Type of Visit (5 Co pliance 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: Arrival Time: 1 d Departure Time: County: C L/S/J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
"Swine Capacity Population
a ❑ Wean to Finish
w` ❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
n Farrow to Finish
u U11ts
❑ Boars
..Other -
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 ` a " Longitude: = ° = ` = "
Design Current " ' Design
Wet Poultry; Capacity ::Population Cattle ;Capacity
Dry'Poiiltry� .
❑ Layers
❑ on -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
RNumber�o�
Discharzes & 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 53 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ONo ❑ NA ❑ NE
❑Yes B<O ❑NA ❑NE
Page I of 3 12128104 Continued

Facility Number: 3 — 3 b Date of Inspection 4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structti;e 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA�6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ClYes 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 eNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C(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 LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J Jr/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
?No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[2"'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L2<
❑ NA
❑ NE
Comments refer to..question #I Explain,any YESanswers and/or any, rommendations er comme is
Use drawingsFoffacility to''better explain situations (use=additional pages as necessary)
a►
�
Reviewer/Inspector Name Phone:
�7
7� -► 1
Reviewer/]nspector Signature: Date:
9
Page 2 of 3 ✓ 12128104 Continued

Facility Number: — a Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes LI No ❑ NA ❑ NE
the appropriate box. . ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
IL1 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking [].CropYield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
�❑
JQ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�2,Ko
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[INA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,Ed o
E?
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
040
❑ 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
��
l,NNo
El NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
LJ 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
ENo
❑ 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
ETNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,,�� //
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
El32. NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
OJ No
❑ NA
❑ NE
Additional Comments andlor'Drawings:
Page 3 of 3 12128104

M,
Type of Visit 6 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Viis-iit(Rouutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 'I /1(p��J Arrival Time: ® Departure Time: County: D11#0Vft0j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ,,��f Title:
6
Onsite Representative: t_ AIAT'W#J Ir�a�04-�
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ` = « Longitude: 0 ° = , [_—] "
r F.-
1111111Capacity
Population
Wet Poultry
Capacity Population
Gtittle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
JEI Non -Layer I
Dairy Calf
❑ Feeder to Finish
ti
(}�d
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ '1 urke s
Other
❑ Other
❑ Turkey Pouets
10 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2n No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KIN
[I 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

0
Facility Number: — 136 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?
❑NA El NE
❑ NA ❑ NE
A Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: IAN&mA)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SU
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes M No ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes O'No
❑ Yes ❑ No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) eat, 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 YNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [( No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CEfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
7No
❑ NA
❑ NE
'Comments�(refertopquestton4#) Egplaia,AanyS;answet�andlorany recommendations or any other comments.
Use dra gof� a lity`to;better�egplarn ituahon5`(u a ad �ti a l pages asnecessary
Reviewer/Inspector Name o Phone: 791
Reviewer/Inspector Signature: Date:
Page 2 of 3 112128104 Continued

Facility Number: —136 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 f
ElYes dO
El NA El NE
El Yes No ElNA ElNE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
LiYes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
db o
ElNA
ElNE
-23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
25.
Did.the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V6No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wt o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
WNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
�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
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

I)d
Type of Visit 0'Co pliance 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: % .%�t a V..j Arrival Time: Departure Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: J ` AJ Atug'0 �:il�l-lr li
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o =.
Longitude: = ° = I =
Design Current
Swine Capacity Population Wet Poultry
Design
Capacity
C►urrent Design Current
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish 36,
❑ Dai Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Layers
❑ Dry Cow
ElElEl
❑ Beef Stocker
Farrow to Finish
ElNon-La ers
❑ Pullets
Gilts
P1013oars
ElBeef Feeder
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
Other
Number of Structures:
❑ Other F❑Other
Discharees & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
El Yes
❑No
[3 NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑Yes
El No
El Yes
L/�ElNA
El NE
El Yes
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 t — j 36 Date of Inspection 7�!
.1
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: W AitMf t A rraaA) L
Spillway?:
Designed Freeboard (in): u
Observed Freeboard (in): S i Ll
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 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ 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 dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ll 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 DNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3NoEl 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 acre determination?❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
2
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Reviewer/Inspector Name o Hr-t-FAQA(G Phone: 60
Reviewer/Inspector Signature: Date: o
Page 2 of 3 12128104 Continued

-�--;
Facility Number: 31 — 3 Date of Inspection 171
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 13 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3N ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If es, check the appropriate box below. ❑ Yes/No ❑ NA ❑ NE
P g P Y
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA [INE
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?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
V 1`+o
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
N
❑ NA
❑ NE
❑ Yes m No ❑ NA ❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �No
❑ NA Li NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes ❑ 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
]n 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
2fNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[;2 No
❑ NA
❑ NE
Additional' Comments atidlor..-Drawings:
Fit
AL
Page 3 of 3 12,128104

(� Division of Water. Quality
Facility Number 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit Qf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
MSC
Onsite Representative:y otlL C--1k_a'T{;�.�_
Certified Operator:
Back-up Operator:
Location of Farm:
Sine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = 6 0 « Longitude: = o E_-1 ` 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laye r
�I 1, JE1 Non -La ei
Dry Poultry
Non -
Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[I Yes L'INo ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
El Yes
El No
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — (3c, Date of Inspection
r
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: to (yo op) t A Cwirzro�j 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): yD
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 L7 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ['To ❑ NA ❑ NE
❑ Yes L'J 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? es ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 'B 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 ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes QNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[I 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
❑ iqo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
a
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
2 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):
U P lDAT(C. W U P U: +k G&MTT SX C u ATvn-fic,
C. 6CA-k Krp 3e 9-4,,t/O A r l ELJ9 S
Reviewer/Inspector Name U t f Phone: ( `Ito) 1 c1(, _ f -3 $,6
Reviewer/Inspector Signature: Date: a- a
17/7R/OQ ('nnlrnr�ad

Facility Number: Date of Inspection '----i=-,
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. 04bP ❑ Checklists `y -, `" El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Cade
dyes ❑ No ❑ NA ❑ NE
lJ Yes Cl No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ErNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LTNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
i ❑ 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
FN El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
;�N`oEl NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9< ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
q< ❑ 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
<0 ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes�`No❑
NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number
5 T : —I—
vision of Water Quality
0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit 9-Iffompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit j2rRoutine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: �V50l2 fY o / -,7 Y Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
//''
Onsite Representative: _ (_ eine / /° � Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Region:L�d
Latitude: = o = 6 ❑ Longitude: ❑ ° ❑ ❑
Design Current.'Design, Current " Design Current
Swine Capacity- Population Wet Poultry. Capacity Population Cattle Capacity. <Populatton l
❑ Wean to Finish ❑ La er
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
FE-]Turkey Poults
❑ Other
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
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
i1
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
❑No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: `
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
(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 of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ 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 [--IPAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind w ❑ Evidence of Wind Drift ❑ A lication Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments 3
q
Use drawings of facility to better explain. situations. (use additional pages as necessary):
gees 17c2ly,
�JP
Ilezv
Reviewer/Inspector Name I 1 Phone:
Reviewer/Inspector Signature: f Date: 611,77 j
Pace 2 of 3 l 28/04 Continued

Facility Number: -31 Date of Inspection rZ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box, ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ 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 Comments and/or Drawings:
W t4
# /o6 3t 3
��of- a.3
Page 3 of 3 12128104

110
Type of Visit oCo piiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CYRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z °1 o 5" Arrival Time: g 4 �r Departure Time: 6 ff o County: ��-= Region:
Farm Name: A6L.(� a2.',� 1 A(L!'n Owner Email:
Owner Name: Phone: 2-5- S68 3-%0
Mailing Address: P.O. (Boyill;._El Q L130z:T<ot) C,
Physical Address:
Facility Contact:
Onsite Representative: � CEO KC— UaJ
Certified Operator: r_ L
Back-up Operator:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: El o = I = 11
Longitude: = ° = I = u
'� *
Design Current . �� estgn' Current
Swine +;C pac t}r"Populat on�WeMoquitwr"'C'.. pac`stj° Po att�on . Cattle F
�:"+ixtsza
Destgn Current
Cad ca ifr Population
❑ Wean to Finish
r ❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
°j �j
Dai Heifer
❑ Farrow to Wean
,
`Dry P.oultr�
" ° °r
El Dry Cow
❑ Farrow to Feeder
Layers
❑ Non -Dairy
❑ Farrow to Finish
El❑ Beef Stocker
Gilts
4 ElNon-La Non -Layers
�_
[] Beef Feeder
❑Pullets
❑ Boars
❑ Turke s
❑ Beef Brood Cow
y
OtherEl Turkev Poults
5
❑ Other
s9 ❑ 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 IJ No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
ElNE
❑ Yes
❑YesWo
❑NA
❑NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number:—3d 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
Identifier:
LA G'DW-
Spillway?:
06
Designed Freeboard (in):
19
Observed Freeboard (in):
3b
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [$No
❑ Yes ❑ No
Structure 5
❑NA El NE
El NA El NE
Structure 6
❑ Yes Vfll;o ❑ NA ❑ NE
❑ Yes WNo ❑ 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 E No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes IJ 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 CNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Eo
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
WNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) &44ny L u s (i0
13.
Soil type(s) _� g
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[7No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
fNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑ Yes
[�No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
� o
❑ NA El NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[`No
❑ NA ❑ NE
€+_SSjrE(ni1c aF Cv.1E6tAb NE6n�D w�[N fZL-[nti�S.
21.) Nlb dZercPrt� 2ft .*>f•At� AVJo j., sN;TSK_ oN PAj �4Cct_ Gti-t s ALOP-�& w3TH
t.>a Liab d LEVE i-S CrLoe 1'r-CLO ►.rEEt'S ['a 03tr 04D
�A rLm tSo ojf_ 06Eos Go 3?3.�5 �� WA�� ANAi,{s �S! erC , Cezo.^ oNsm- a_&f, roP g(,S_
Reviewer/Inspector Name �0 1i f-jPhone: (g lQ,) 3C13 34.
Reviewer/Inspector Signature: Date: 2/.f d5
12128104 Continued

Facility Number: 31 — Date of Inspection a
Required Records & Documents
19. Did the facility'fail to have Certificate of Coverage & Permit readily available? dYes ❑ N� ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [YNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ 7aste Application ❑ Wee y Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers ❑ Annual Certification
E Rainfall El Stocking Crop Yield ❑ 120 Minute Inspections dMonthly and I" Rain Inspection;�No
Weather Code
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 o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
L✓I No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Ld'N
❑ NA
❑ NE
❑ Yes
lJ No
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
`Additional Comments and/or Drawings:
❑ Yes
D N' o
❑ NA
❑ NE
El Yes
L1J No
❑ NA
❑ NE
❑ Yes
EYNo
❑ NA
❑ NE
❑ Yes
[I/No
❑ NA
❑ NE
El Yes
� N N❑
NA
❑ NE
El Yes
No
❑ NA
❑ NE
12128104

Type of Visit Q Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit -QRoutine (:)Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: �� 0 Time:
/
Not O erational 0 Below Threshold
10 Permitted P&Certified E3Condixtionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: _,&I teJ Cll A6r,A4- _ County:
Owner Name:
Mailing Address:
Facility Contact: / Title:
Onsite Representative: 1r_ h Q A limit .tr
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 4 " Longitude ' 1 Du
ine
Design Cu ent11 Nil Design Current Design Current
Ca aci P,o ulation Poultry Ca aci Po ulation Gattl_e Ca acity P,o ulation
o Feeder
❑ La er
❑ Dairy
Ito
Finish
❑ Non -La er ❑ Non -Dairy I
Total Desin C►aaciTotal SSI,W
to Wean
[NE
to FeederOther
to Finish
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-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 Iecti n r z 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): 3 It
0510.3101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number. 2L —agDate of Inspection ZZ
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 stucrures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markines?
Waste Annlication
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
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?
13. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Retguird 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?
(ie/ WUP, checklists, design. maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the faciliry 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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ lees ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Io No violations or deficiencies were noted dating this visit. You will receive no further correspondence about this visit.
�...r"•-'a.Sgn"r�`��f.+we.�x+
Coi etrts,{refer to gnestaoii .:E plain:aiiy Y)E�S' answers -anchor axtty recom menilatEotts or any other coiume
Use drawing's of i €ailxity, to better explain sttnation.L_(nse additonal'pagesas necessary) y-
- c ❑Field Copy ❑ Final Notes
. g _ y;
Reviewer/Inspector Name .`' ' ' �� �; xa
Revieweranspector Signature: Date: Z;
05V310I r Conrinued

Facility Number: 31 - ! Date of Inspection 1I d
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? (Le, 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 p6rmanentltempor3ry cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional. Comments andlnr Dowmgs: �:.: a..
AL
05103101

Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit gRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
LFacility lumber Dateor isit: Time: [ z: Not Operational 0 Below Threshold
M Permitted UCertified 0 Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: _ ifin r TQi✓m County: - fll, MI), _-
Owner Name: Art / rt Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: f/.lei B / 41117 1 Pi&
Certified Operator:
Location of Farm:
Phone No:
Integrator: ua4ve T
Operator Certification-' Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude rr�0 C 0` Longitude '
Design Current Design Current Design Current
Swine •Ca acity :Pe ulation - Poultry Capacity Population ' :Cattle,;:. Capacity Population
❑ Wean to Feeder JEJ Laver I 1 11❑ Dairy
91 Feeder to Finish ❑ Non -Laver ❑ Non -Dal
❑ Farrow to Wean - - - -- - -
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish - Total -Design Capac>Ity ,
❑ Gilts
❑ Soars _ Tptal'.SSLW
. ; r Number iif Lagoons , yr Z� _ ne subsurface Drams Present ❑ La oon Area Spray Field Area
vHolding Ponds 7 Soltd Traps
,, �" s ❑ No Liquid Waste Management System ix a
Discharges & Stream Impacts .
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lap-oon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. 1f 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 galimin?
d" Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
❑ Yes ® No
❑ Yes. ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes MNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes F[ No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t Z_
Frecboard (inches): 2�7_ 2_6
05103101 - Continued

�.,Y•. :ems: �-� ".. __
Facility Number. 3/ — rjb Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees. severe erosion.
❑ Yes
2SNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If
(lf any of questions 4-6 was answered yes, and the situation poses an
Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
® No
' 8. Does any part of the waste management system other than waste strictures require maintenance/improvement?
❑ Yes
® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
® No
Waste Application
1 10. Are there any buffers that need maintenance/improvement?
❑ Yes
N No
l 11. Is there evidence of over application? El Excessive Ponding PAN ElHydraulic Overload
ElYes
®,No
• ,D, ' �+❑
12. Crop type 144r) �ir�lt�F4__(��Zti �� .�5t�r/ � 4�� Dvr�set� ��t,,t[/ lsJ,�.�►/�.,
�4
�s�S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
® No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
❑ Yes
S No
15. Does the receiving crop need improvement?
❑ Yes
R No
16. Is there a lack of adequate waste application equipment?
❑ Yes
E4 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
E, No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
R1 No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
&�No
20_ is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
®No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
S No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
L.No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ON No
24. Does facility require a follow-up visit by same agency?
❑ Yes
N No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
U[No
No violations or deficiencies were noted during this visit. You will receive no further. correspondence about this visit.
_
mr
suantuttw:
�gts�smeces�ar): Field CopyEj Final Notes
wU `l*s
,k97- 6e -,I 3�1% �itt -tQv
�J4✓�t rd4 d- l�i�� /tet y[ G'/6S[ �771ii7%�ost 3
t t�✓ -fe hel
p
.4l n
7
kieals /�-ee• -h k lu J �o .t Q/lam efe Qr,.�.'4C tv
�°
i--4i d-
Reviewer/Inspector Name
�. '�
_
Reviewer/Inspector Signature:
Date: Z
05103101
Continued

FaciEii}° Number: f — �jp Date of Inspection
Odor Issues
26. Does.the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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?
❑ Yes g No
❑ Yes �4No
❑ Yes ftNo
❑ Yes ZNo
❑ Yes 5�No
❑ Yes JZ No
❑ Yes Q9 No
O5103101

Facility Number Date of Visit:® Time:
Not Operational Q Below Threshold
Permitted [3 Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
.........................
Farm Name:`.9.............................................................. County:.- ..1,....... ...._................
. - - ... .
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................... .
Facility Contact: .....................:........................................................ Title:
PhoneNo: .................. . ... . . . . . . . _...
MailingAddress: ..........................................................................................................
....
Onsite Representative: .,r��r-s...4``'`s-.........................................
Integrator:.....'.'.."- st4 h . .
Certified Operator: ................................................... .
................ Operator Certification Number:.....
Location of Farm:
❑ Swine ❑ Poultry []Cattle - ❑ Horse Latitude ' 4 « Longitude • 4 «
Desi Current Design Current - Desi gn gn gn -y CaiiTtnt
;Swine Poultry . _Ca ci Capacity Population Po anon ,_
Wean to Feeder ❑ Layer ❑ Dairy = -
Weeder to Finish q8qga Non -Layer I Q Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish TOW Design Capacity
Gilts = . _
❑ Boars TolhdSSLW
=Number of LagDons ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps;: ❑ No Liquid Waste Management System
Discharces & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
' b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
�(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
10 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure G
Identifier:............................................................................................................................................... ....................................
....................................
Freeboard (inches):a
5/00
Continued
on back

FaciEity-Number: -3 ` — N 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 Auolication
10. Are there any buffers that need maintenance/improvement?
11. Is there evide c of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type ( 6 ( 4$
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?
0' NO-yiblati00s :or def cjtep�ib� 4g a ngteo dikei fig tjtis: visits . Yoi� 0t dj t& , We iio fut th�x
. • coriesnotidence: about: this visit. ...........:....................... .
❑ Yes 9No
❑ Yes eNo
❑ Yes ONo
❑ Yes X1 No
❑ Yes XNo
❑ Yes 0�10
❑ Yes KNo
❑ Yes KNo
❑ Yes ONo
KYes ❑ No
❑ Yes ❑ No
❑ Yes Z No
❑ Yes 9No
❑ Yes KNo
❑ Yes 9No
)KYes ❑ No
❑ Yes ANo
❑ Yes IgNo
❑ Yes No
❑ Yes No
❑ Yes ( No
❑ Yes No
Comments (refer to `gtiiestion #) A Ex Wn any YES answers and/or any`recommendations or any other eo"mmenta
Use drv4injs of fa e lity.t6 better eiplain situations (use:additional:gages
r7) -yeah 1�-, ��--� t `-��e�-- N c2. c.. �« -"s 0,-,
C)(
ty

Faciu`ty Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor 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
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
�+No
roads, building structure, and/or public property)
�11
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32,
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
_ . tiv . omments an or rawmgs•
.a.�- �"-� c71 ir�--v��-►-�� �( C Ott ��-
�-.e�-
v
w
5/00

Lagoon Dike Inspection Report
Name of Farm/Facility Ano 3/ —/ 3 0
Location of Farm/Facility Se 1 !
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Siope,xH:IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
z?Z
9Sc) g
2 Names of Inspectors 1
r
I Freeboard, Feet 1
,r Top Width, Feet g
Downstream Slope, xH: IV J _�
Yes ----No
Yes No
Erosion? Yes /----No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
. Follow -Up Inspection Needed?
62 USs l lager '
Yes No If Yes, Depth of Overtopping, Feet
Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes ---No

Routine O Com laint Q Follow-upof DWQinspection Q Follow-upof DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted C] Certified [3Conditionally Certified 0 Registered [ Nat O erational Date Last Operated:
Farm Name:~Q.w1 County:......... ......................................................
.............................................................
OwnerName:........................................................................................................................... Phone No:
Facility Contact: .............................................................. .......Title Phone No:
MailingAddress: ....................................................................................................................................... .................................... I.............................. ..........................
Onsrte Representative:t"���...,L�•••••„••••,.,,.•..,, Integrator: ..— ............
. ........ ---- •...............
Certified Operator : ................................................... ............................................................. Operator Certification Number:.--........------.........................
Location of Farm:
Latitude Longitude �� • �' �"
Deli v .-
gtn ' . Current .:; Design Current" Design 'Current
Swine „capacity Po illation . `Poult
p ry Capacity, Population . Cattle Capacity" Population
❑ Wean to Feeder
Weeder To Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of I agoons ❑ Subsurface Drains Present ❑Lagoon Area, ©Spray Field Area
Holdmi Ponds:'/Solid Traps ❑ No Liquid Waste Management System
-: 1t
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, slid it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes rxrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than.from a discharge? ❑ Yes (ZNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............ �35............ .................................... ....................
5. Are there any immediate'threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [�(No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 — 'jb Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
ONO
closure plan? .
❑ Yes
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
�(No
8. Does any part of the waste management system other than waste structures require maintenancetimprovement?
❑ Yes
[XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
JXNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
LYNo
A'
12. Crop type b p r U, SG 15 o'
.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
)<No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
NrNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
RrNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
ONO
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20: Is facility not in compliance with any applicable setback criteria in effect at the time.of design?
❑ Yes
ONO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
CKNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9No
24. Does facility require a follow-up visit by same agency?
❑ Yes
JKNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
gNo
�46 •yiblatigris:or de%rcienci$s -wire irbted• diWirig fbis:visit; - Y:oir will •rebf&4e fio furth& -
- corresbor ideirce: ahoi uk this visit:
``�� �`"��11�-. �p p�, c��i��r- �t � �� �s� ► �t � � ve,r �-6r�r�� �,i l�-c.. 5�.��c� `
ksc
Reviewer/Inspector Name
Reviewer/Inspector Signature: ® Date:

A
Facility Number:-6 — `30 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
A No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
J?�No
roads, building structure, and/or public property)
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
XNo.
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
9No
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?
KYes
C'No
Additional Coinments an.. or eawings'-
►11
3/23/99

Facility Number Date of Inspection 9
Time of Inspection 3 24 hr. (hh:mm)
Permitted [3 Certified Q Conditionally Certified 0 Registered JE3 Not O erational Date Last Operated:
Farm Name: .-...... ham- County :............� 1...`'�...
Owner Name: ......... . .
Facility Contact: ........................
Phone No:
. Title: ....... - .... ...-.......I............ Phone No: ...--•.......................
MailingAddress:................................................I...........:..................r.........................................-............... ................
Onsite Representative:....-��-..........�?. . ../.......... Intei,rator:......."'��
.. �?y........
Certified Operator:................................................................................................................ Operator Certification Number:
leatiopof ar
12 -- ......... ................sl............................................................... ...... ...........►" l.:..............................
........ :..J••4.1Ai!N3........................................ .............................................................................................................................................................................................. T
Latitude Longitude �• ��
-Design Current Design Current Design. Current
Swine. -Capacity Population Poultry Capacity - Population Cattle Capacity Popiilatton 7.
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Feeder to Finish L1956 ❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other =• A
❑ Farrow to Finish Total Design. Capacity
❑ Gilts ,
❑ Boars _ Total SSLW
—Number--of Lagoons ® ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
-Holding:Pofi&J Solid Traps E== _ -V ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Uf,No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Dices discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes b(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ........... 3 ............................................................................................................... I ...................
.......
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes kNo
seepage, etc.)
3/23/99 Continued on back

Facility Number-. 3 — 3 Date of Isispection
•
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 maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type So�11„FGL , � p , �A' . -54
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?
�Vo yii hti4ris:or dt#icien6t,9 *ere noted• dirrtfig this:visit: • :Y:oir will •reeei ei iio further
. . correspondence. aht7ut tills .visit_
❑ Yes 9No
❑ Yes (No
❑ Yes V14
❑ Yes [)kNo
❑ Yes D�No
❑ Yes CRrNo
❑ Yes RNo
❑ Yes LKNo
❑ Yes No
Yes ❑ No
❑ Yes "No
❑ Yes 19 No
❑ Yes C[ No
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes N'No
❑ Yes ZNo
❑ Yes &NO
❑ Yes 00 No
❑ Yes & No
3123/99

Facility Number: Date of Inspectian
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor below
Yes
[ 1Vo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
9No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
KNa
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(NO
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
KNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
[�No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
WNo
3123/99

13 Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
Routine • O Com laint O Follow-up of D«' ins ec€ion O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection ! 24 hr. (hh:mm)
© Registered [3 Certified © Applied for Permit 13 Permitted 0 Not OperationalOperationall Date Last Operated:
Farm Name: >\
n................................................................
t z1......� Y7Lli? ,,. Co
......�.......... �,:.......................................................... €tntv:.....t'.0 ! ^.
Owner Dame ..................:........L tf12-K.41........................------------.... Phone No:....�9.� ..v. �1.?F 1....... .................
Facility Contact : ...................... .......:...,...,.. Title: Phone No:
p...... .[............ ....................................................................... ...................................................
Mailing Address:..... .....L�......S.k.:[uk1...... ..................................... ......... .Y :IS°^... NC ....................... ? ........
OnsiteRepresentative:.......11� n .... 1r1................................................................. Integrator:.....�...........................................................
Certified Operator-,. ............................................ .... ..................................................... Operator Certification Number:................ .
L'ocation of Farm:
X....r ..................-a-_t.5.4S~.1.6* ....:.......................................................................................................
................................................... ............
General
L Are there any buffers that need maintenancelimprovement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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 lagoonsiholding 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 0 No
❑ Yes Ca No
N 1A_
❑ Yes No
❑ Yes No
❑ Yes M No
❑ Yes q9 No
❑ Yes [P No
❑ Yes No
Continued on back

Facility Number: 1 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fl.a goons �Ilolding Ponds blush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure ? Structure 3 Structure 4
Identifier: I,('Z
Freeboard(ft): .......... I nk ............................................................................................................................
10. Is seepage observed from any of the structures?
11. is erosion, or any ether threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement!
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste Application
❑ Yes PU No
❑ Yes n No
Structure 5 Structure 6
Yes ® No
❑ Yes [&No
X Yes ❑ No
❑ Yes'r'71 M No
14. Is there physical evidence of over application? ❑ Yes if No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type 1 yr S 1f ...........5 .......q � Csa ............... Ul f .....1�... O tN11<Vk.i.... [ ... r� klt ........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW;YIP)? ❑ Yes No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes M No
18. Does the receiving crop need improvement?
r
Cl Yes
No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
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
Q No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes]
No
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
No
0 No.violations or deticiencies were noted- during this.visit..You.will receive no further
. correspondence about this visit:
7/25197
F
Reviewer/Inspector Name.''
Reviewer/Inspector Signature: � _� — _ Dater it If I l q Q

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
August 14, 1997
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Ann Herring
Ann Herring Farm
292 Bill Sutton Rd
Albertson NC 28508
Farm Number: 31-130
Dear Ann Herring:
096MA,
A&14 00
C)EHNR
You are hereby notified that Ann Herring Farm, in accordance with G.S. 143-215.1OC, must
apply for coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your
farm has thirty 30 days to submit the attached application and all supporting documentation. In
accordance with Chapter 626 of 1995 Session Laws (Regular Session 1996), Section
19(c)(2), any owner or operator who fails to submit an application by the date specified
by the Department SHALL NOT OPERATE the animal waste system after the specified
date. Your application must be returned within thirty (30) days of receipt of this letter. Failure to submit
the application as required may also subject your facility to a civil penalty and other enforcement actions
for each day the facility is operated following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Forrri. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package. The
signed original application, one copy of the signed application, two copies of a general location map, and
two copies of the Certified Animal Waste Management Plan must be returned to complete the application
package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Permits and Engineering Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any question concerning this letter, please call J R Joshi at (91.9) 733-5083 extension
363 or Dave Holsinger with the Wilmington Regional Office at [phone].
Sincerely,
A. Preston Howard, Jr., P.E.
cc: Permit File (w/o encl.)
Wilmington Regional Office (w/o encl.)
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

❑DSWC Animal Feedlot Operation R view x£°
s �DWQ4Animal Feedlot Operation SIte Inspection ,-,
IG Routine O Complaint O Follow-u2 of DW2 inspection O Follow-uE of DSWC review O Other
Date of Inspection 5
Facility Number
Time of Inspection : ! 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered [I Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted for Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:.... ...... _.........._.............. ........ _....... _........ ........ .......... ........ ......... ..._..... _..... ..........
Farm Name: __ a Li - s�r.rr +.L .... ,..... .. _.... Cou nty:..b 5 .!^_ .. .... ..... _.....1t1.�.1. ,�
Land Owner Name:Phone No:
Facility Conctact: _ _.............,............ .......... ......... .._..... ...... Title: Phone No:
]Mailing Address:.._..17........ LILIA.....s. z....... _........ ......7...
� �.......... .... �.�.�. ��.. .........
OnsiteRepresentative: ... ,]..ra ...ri,;r.3�.... ......... __....-Integrator: 1_
C c 1
Certified Operator: ...... .....43L'{.t:E....,....... ..........._.......,...., Operator Certification dumber:
— —
Location of Farm: _..
..Qxa...... _qA . a ...._.i.
..:....... _........ .._............. ........................... ._.............. ...... .... ....... _.......................................
_... -- ...... a
LatitudeLongitude ©•®�"f'"µ
Type of Operation and Design Capacity r
_ Fh -- --.. > .,vx _.
Srv�ne - Design Cvrrentt - 'Design = Current .Design Curren
Ca aci . Pout? 3' a Cs artv Pi'on Cact =Po ulahonPouatidn
❑ Wean to Feeder : ❑ Layer . ❑
[29 Feeder to Finish '. ❑ Non -Layer ❑ Non -Dairy
Farrow to WeanFFF,
Farrow to Feeder ity
11 Farrow to Finish '#
.� ., "
m.
___ _....... Total SSLW 0
Other '
{ �s
ENu _ber of Lagov s'f 61dmg Po ds ❑ Subsurface Drains Present
f ❑Lagoon Ar❑Spray F ea ield Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 19 No
2. Is any discharge observed from any part of the operation? ❑ Yes ],No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes JR No
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ) ❑ Yes 14 No
c. If discharge is observed, what is the estimated flow in gal/min? Q
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 KNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? [:]Yes R) No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes $1No
4/30/97 maintenancelimprovement? Continued on back

Facility Number:..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes JRrNo
❑ Yes 19 No
❑ Yes IN No
❑ Yes 13 No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type �>....... ...... —........................................... _ .-................ ......... .......... -........
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 Ccdfied
Eacilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes (.No
❑ Yes KNo
® Yes ❑ No
❑ Yes 9No
❑ Yes ®,No
❑ Yes ENO
❑ Yes 9[ No
0 Yes
❑ No
❑ Yes
%No
❑ Yes
9No
❑ Yes
RNo
❑ Yes J-No
❑ Yes a No
91 Yes ❑ No
...O ri eats {refer to questionf#) Explain°any YES answers'and/or.any reconunendations or any other comment§
Use_dzawings of facility to better explain situations (use addihana. pages as necessary}
12. Cat Stirubt c�. o.:��.r R�d�v�Wall, i� cavn X u_x 1h OL
V e E o` t; a .-. i r, {�., : S v� 0 C1.. e r „S i C-e 0 0 ,•• �s a� i f i o n
d. .J
it • ru t t c- a r +- 0 W e a-e1� vb % [ e...,,, S w• v 4_'. .
a-v t ck- Gv v v e-�.. C L a c vj w a S t t 0. L
1 v-�.
c t K_w ►'' e- c- d - s a K- S; t l �j o v c7�a ...� t K wv a cr v �r ,r++--•1 �i
Ice- e_. 1 . C dl Q--" 6 c )c
Reviewer/Inspector Name .. „ .� �,.; � , Reviewer/Inspector Signature: Date: R
I;—
cc.- Division or Water Quality. Water Quality Section. Facilitv Assessment nit 4/30/97

Site Requires Immediate Attention:
Facility No.
DWISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:- t a o_o
Farm Name/Owner:_4W;-, t., it/k12,-VA ✓ kN,
Mailing Address: ��1�- ✓�'t! S„�� vim- �"--t5All S-
County:
Integrator: cQu Phone: 3l v
On Site Representative: 1D , rjLu ek r,11 Phone — 3
Physical Address/Location: zve S.k r i H� _t ��u ►�. �.r _ n. 4
Type of Operation: Swine- ✓ Poultry Cattle
Design Capacity: 1aDb IVY Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
` Latitude: ° D Longitude: _'7-7 ° _` Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: `Ft. 0 Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Y or No
Is adequate land available for spray?()�qi or No Is the cover crop adequate?,�Oor No
Crop(s) being utilized: iy L&±1 �! SPL+ A
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Q or No
100 Feet from Wells? &Qor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land ,ajplied,
spray irrigated on specific acreage with cover crop? Yes or No
Additional Comments: '
11
r ,. . � L .M-As 1
L I E1111111titat • ' , i
Inspector Name Signature
cc: Facility Assessment Unit IUse Attachments if Needed.

•
Site Requires Immediate Attention:
Facility No. 7 /
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECO 'P 13
DATE: , 1995
Time: r 17 /
Farm Name/Owner: YoaeP k Q
Mailing Address: 3 D
County.
Integrator:
On Site Representative:
Physical Address/Location:
Type of Operation: Swine
Design Capacity: 3C-00
Phone:
Phone: .3 6&-
Poultry Cattle
Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft_ Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage. with cover crop)? Yes or No
rtra
,rd1. �l�i' ' r . A . u
/_/04 2 !�l V:e i'-
In'spector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

OPERATIONS BRANCH - WQ Eax:919-715-6048
Jul 20 ' 95 19 :19 P. 08/ 15
0
•
Site Requires Xnumediate Attehtion
Facility Number,
SITE VISITATION RECORD
DATE; - 0 , Y99S
Owner: il4 1 � _ ! Farm Name:
County: 1 it
Agent Visiting Site: TN_ -, ,._.. Phone: _ _ -
Operator: Phone:
On Site Representative: Phone: ,
Physical Address: 11 IV r .,- SK L t
Mailing Address:
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: W t_ Numbez of Animals on Site: lid
Latitude: o ' �," Longitude: -- 0 '
Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately, 1 Foot + 7 inches) Yes or No Actual Freebaard:.r, Feet _ Inches
Far facilities with more than one lagoon, please address the other lagoons' freeboard under the
comIl nts section.
Was any seepage observed from the tagoon(s)? Yes or(9 Was there erosion of the dam?: Yes 00
Is adequate land available for land application? Yes or No Is the cover crap adequate? Yes or No
Additional Comments.
•
11
Fax to [phone] Si :ature of Agent

Site Requires Immediate Attention:
Facility No. 3 1 — I o
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1195
Time:'--]J
Farm Name/Owner:
Mailing Address' _
County: i '000V J
Integrator: LzdlPhone:
Oti Site Representative: /U N Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: �� D
DEM Certification Number: ACES DEM Certification Number: ACNEW
Latitude: ✓°�" Longitude:' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: /— Ft. —e-g-, Inches
Was any seepage observed from the lagoon(s)? Yes oreoWas any erosion observed? Yes or 70
Is adequate land available for spray? Ye or No Is the cover crop adequate? or No
Crop(s) being utilized: W l—' *4ft::�e
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Gor No
100 Feet from Wells?_ es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 3 0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Bluc Line? Yes or 10
Is animal waste discharged into waters of the state by man-made ditch, flushing system' or other
similar man-made devices? Yes or� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray, irrigated on specific acreage with cover crop)? Yes or o
= Additional Comments: % ca
Inspector Name
cc: Faciliiy_Assessment Unit
4;w
Signature
Use Attachments if Needed.