310567_INSPECTIONS_20171231

NQHTH CAHOLINA
Department of Environmental Qual

(Type of Visit: O'Com ' nee Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access 11
Date of Visit: I 7 Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact: I / 1� / Title: Phone:
6v Onsite Representative: �/ [� U [ p l r l 5 Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design 'urrent
Swine Capacity Pop.
Wean to Finish
Design C*urrent
Wet Poultry C*apacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
DairyHeifer
Feeder to Finish
Farrow to Wean
Design Current
Dr. P,o_uIt , C_a aci P,o ,
Layers
D Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes YNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [N o
[:]Yes INo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

[P—acility Number: - 7 Date of Inspection:
Waste Collection & Treatment
4. I'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [i]' ]�o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 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 6 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
b
❑ Yes
E3No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[]-llq-o—❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ 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
Now❑ 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
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
❑ Yes
10 ❑ NA
❑ NE
the appropriate ox.
❑ WUP ❑ Checklists ❑ Design [:]Maps [:]Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 31 - T a ZI jDate of Inspection:
24. Did thqofacility 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 es ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 E]-Ko❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Signature:..-- Date: s/7/ 7
Page 3 of 3 21412015

Type of Visit: P<ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up 0 Referral O Emergency O Other O Denied Access ` �j
Date of Visit: a?-- / /Arrival Time: eparture Time: ..County: / Region: liyJ1 �
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current Design Current
R'et Poultry Capacity' Pap. Cattle Capacity Pop.
La er DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design Current
1) > P,oultr, Ca aci P,o ,
Layers
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Ill
Pullets
Beef Brood Cow
QtherI
Other
Turke s
Turkev Poults
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Jio ❑ NA ❑ NE
❑ Yes )ZrNo ❑ NA ❑ NE
❑ Yes ;ErNo ❑ NA ❑ NE
❑ Yes A No
❑ Yes 2fNo
❑ Yes Rio
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ,0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ;'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes � No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes gfNo
❑ 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 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [ErNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 'PrNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes /f I 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 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .J�fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ONo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes O No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �No
'�'�N'
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes f o
❑ 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 J5 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes T5 No
i
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 72P jDate of Inspection: L
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 ENo ❑ 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 4,No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [ f No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes XNo
❑ 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 Z No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes VNo
❑ NA ❑ NE
❑ Application Field [3Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes P No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary}.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214/201I

_ _ w.•�"Givision of Water Qualtty: �� � "'
h Ci11 uDivision of Soil and, -Water Conseryatmon u`
Q Other AgencyT:
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3d `Arrival Time: L yDeparture Time: County: Region&f�
Farm Name: 2%1 7 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �A07e
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator• A ZzS
Operator Certification Number:
Back-up Certification Number:
Latitude: = ' 0 « Longitude: = o
= °� Des>gn Current Design% "Current'" Ds Current
Capacity` Population ry . Capacity Popuulatton.
Cattle k C p city Population
ry
a.-�. �,.
❑
Wean to FinishK
= ❑ Layer
❑ Dairy Cow
❑
Wean to Feeder
❑ Non -Layer
❑Dai Calf
s El Feeder to Finish;
D
- ❑ ai Heifer
❑ Farrow to Wean
��� -
El Dry Cow
D Poult
❑ Farrow to Feeder
"� x "
-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
ElNon-La Non -Layers
"
❑ Beef Feeder
❑ Boars
` ❑ Pullets
❑ Beef Brood Co
',
❑Turke s
d
❑ TurkeX Poults
❑ Other I, ILI Other
�F Number�oructures :�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �Mo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
❑ Yes
Ef No
❑ NA
❑ 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?
a. If yes, is waste level into the structural freeboard?
Stntc ure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (its):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes L1 No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Structure i Structure 0
❑ Yes
[1,No
❑ NA
❑ NE
❑ Yes
T
VNo
❑ 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 [�Ao ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes %O ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�+No El NA El NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
)�l No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:] Yes
P?rNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments.
-Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: —�
Reviewer/Inspector Signature: Date: 3
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo ❑ 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
IG No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[f No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[FNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
; l&
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
6o
❑ 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?
11
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)
ElNE
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
to
ElNA
33.
Does facility require a follow-up visit by same agency?
❑ Yeso
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

FittyNumber
>ion of Water Qt ahty
Tian of Soil and _ ater.Conservatton
T Avenev,
Ft'
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit .0"Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �eparture Time: County: Region:
Farm Name: 21__ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:Integrator:I IF
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 n = = Longitude: = ° 0, = "
Design Current Design Current Desigr Current;
Swine Capacity Population , .._ Wet Poultry CapaeityPopulitionrCattle-apacity,PQpu
.�d'C 1ation
%'Ak">• Y �w - "^wRN e. - .a. Mil .k e
�,. .. .. Y. .:.....o _..<. M,
„ ❑ Wean to Finish • ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish*
❑ Farrow to Wean I)ry Poultry" =�
❑ Farrow to Feeder
"- ❑ Farrow to Finish El Layers
❑ Gilts ❑ Non -Layers
❑ Boars El Pullets
❑ Turke s
Other _ ❑ Turkey Poults
❑ Other I ❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Broad Coyd
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
WNo
❑ Yes o ❑ NA ElNE
ElYes-
Ll 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 ,0 No ❑ NA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes �No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No El NA [3 NE
(ie/ large trees, severe erosion, seepage, etc.) ((�
6. Are there structures on -site which are not properly addressed and/or managed El Yes U� 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 YfNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EdNo ❑ 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 V 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 ❑ 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 6 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Cl Yes
[o
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
Ix No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2fNo
❑ NA
❑ NE
Comments (refer to .question ##). Explain any YES answers and(or any recommendations!or;a)ny�other comments"
Use draw►ngs of fac>lity to l etieraegplam situations (use�add�haital pages 40ticessary) g
o
IReviewer/Inspector Name L n J '. v Phone: Q
Reviewer/Inspector Signature: Date: Y ! �__
Page 2 of 3 12IY8104 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VIVO ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers! ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
_0
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
U(No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[INo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EX. o
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
/(No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VfNo
❑ 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
—V'Je'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
VfNo
❑ 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
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
Cl NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

vision of Water Quality
Facility Number 7 O Division of Soil and Water Conservation f
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: it Arrival Time: 3 Departure Time: County: _1.4'1 Region: 6t
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: 'l
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certtfication Number:
Back-up Certification Number:
Latitude: [= o = 4 = « Longitude: = o =' = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: E]
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 ZJ`No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes . IN ❑ NA ❑ NE
El Yes JiJ No ❑ NA ❑ NE
12128104 Continued

Facility Number: 21 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Xlo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ONo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ;:INo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes .dNo
❑ 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 J:]"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ffNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ETNo ❑ 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. [I�,
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 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
L3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
PKo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R<
❑ NA
❑ NE
Reviewer/Inspector Name �GyLn ` . Phone: Ml' - ICJ
Reviewer/Inspector Signature: Date: ,3
rage _- of 3 1 Ziioivw 4(Nsusit"C"

Facility Number:Date of Inspection 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ko ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z6No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 01 o ❑ 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
Efiio
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J:lNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JD -No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El -no
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0,96
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes L]-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 [allo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [2-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes E'Fro
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Q o
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes ,F� 1�20
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104
12128104

Facility Number 7
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: a Departure Time: County: l�Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: = = 0 Longitude: [� o [= d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Other
❑ Other I- - - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
ElDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CowL
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes .No ❑ NA ❑ NE
[--]Yes [--]No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes - T'No
❑ Yes ;EI-No
[:1 NA
❑ NE
❑ Yes ;],No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 42*
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA [I 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 oNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes yNo ❑ 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 [N ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 4- ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PrNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ 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
P�'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑l/o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑)eo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name C U Phone: U—
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ep o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L'' N* o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes L'No
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
7No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Cl Yes
[ KNo
[I NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
//To
❑ NA
El
26. Did the facility fail to have an actively certified operator in charge?
El Yes
El NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
�/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[;j'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ed 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
ElYes
No
[I NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
Zo
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�Zo
❑ NA
❑ NE
Additional Comments and/or Drawings:
7�
12128104

IType of Visit .<FCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visq­eRoutine O Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 0d 1 De
p
a
rture Time: County: Region: ` A;?
Farm Name: ,2 / ` Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: l�
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ c 0 ` =" Longitude: 0 ° "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
C►attle C►►specify Population
❑ Wean to Finish t
10 Layer
❑ Dairy Cow
❑ Wean to Feeder I
JEI Non -La er
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
El Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Struc#ures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

.s�
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
Struc re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(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 ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ 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 #): 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):
(X/� /� �cJ
':
Reviewer/Inspector Name v . �� f —�f Phone:
Reviewer/Inspector Signature: �_ Date:
Pape 2 of 12 8104 Continued

Facility Number: — Date of Inspection O
Waste Collection & Treatment
. 4orage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ 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 ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windopw� ❑ Evidence of Wind Drift ❑ Applliication Outside of Area
12. Crop tyPe(s) /, e �l S 6 62�',
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 #): 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
AL
Reviewer/Inspector Name Z Phone: 91 - " 7
Reviewer/Inspector Signature: Date.
Page 2 of 12129104 Continued

3/--5'�7
OF WA rF9 Michael F. Easley, Governor
O� QG William G. Ross Jr., Secretary
�North Carolina Department of Environment and Natural Resources �I� rE�
Alan W. Klimek, P. E., Director
U1 Al ��04 Division of Water Quality
N
-- 25, 2004
Murphy -Brown, LLC
2149 Farm
PO Box 856
Warsaw NC 28398
Subject: Certificate of Coverage No. AWS310567
2149 Farm
Swine Waste Collection, Treatment,
Storage and Application System
Duplin County
Dear Murphy -Brown, LLC:
In accordance with your request for a change in operation type received on June 9, 2004 and in
accordance with the directive of Senate Bill 733, we are hereby forwarding to you this Certificate of
Coverage (COC) issued to Murphy -Brown, LLC, authorizing the operation of the subject animal waste
collection, treatment, storage and land application system in accordance with General Permit
AWG 100000.
This approval shall consist of the operation of this systemm including, but not limited to, the management
of animal waste from the 2149 Farm, located in Duplin County, with an animal capacity of no greater
than an annual average of 1627 Farrow to Wean swine and the application to land -as specified in the
facility's Certified Animal Waste Management Plan (CAWMP). If this is a Farrow to Wean or Farrow to
Feeder operation, there may also be one boar for each-15_sows. Where boars are unneccessary, they may
be replaced by an equivalent number of sows Any of the sows may be xeplaced by gilts at a rate of 4
gilts for every 3 sows
The COC shall be effective from the date of issuance until October 1, 2004, and shall hereby void
Certificate of Coverage Number AWS310567 dated May 1, 2003, and shall be subject to the conditions
and limitations as specified therein. Pursuant to this COC, you are authorized and required to operate the
system in conformity with the conditions and limitations as specified in the General Permit, the facility's
CAWMP, and this COC. An adequate system for collecting and maintaining the required monitoring data
and operational information must be established for this facility. Any increase in waste production
greater than the certified design capacity or increase in number of animals authorized by this COC (as
provided above) will require a modification to the CAWMP and this COC and must be completed prior to
actual increase in either wastewater flow or number of animals.
If your Waste Utilization Plan has been developed based on site specific information, careful evaluation
of future samples is necessary. Should your records show that the current Waste Utilization Plan is
inaccurate you will need to have a new Waste Utilization Plan developed.
The issuance of this COC does not excuse the Permittee from the obligation to comply with all applicable
laws, rules, standards, and ordinances (local, state, and federal), nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
Upon abandonment or depopulation for a period of four years or more, the Permittee must submit
documentation to the Division demonstrating that all current NRCS standards are met prior to restocking
of the facility. AP
10MR
Non -Discharge Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
Customer Service Center
An Equal Opportunity Action Employer
Intemet http://h2o.enr.state.nc.us/ndpu
Telephone [phone] Fax [phone]
Telephone [phone]
501/o recycled/109/u post -consumer paper

Per NRCS standards a 100 foot separation shall be maintained between water supply wells and any
lagoon or any wetted area of a spray field.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
If you wish to continue the activity permitted under the General Permit after the expiration date of the
General Permit, an application for renewal must be filed at least 180 days prior to expiration.
This COC is not automatically transferable. A name/ownership change application must be submitted to
the Division prior to a name change or change in ownership.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual permit by contacting the staff member listed below for information on this
process. Unless such a request is made within 30 days, this COC shall be final and binding.
This facility is located in a county covered by our Wilmington Regional Office. The Regional Office
Water Quality Staff may be reached at [phone]. If you need additional information concerning
this COC or the General Permit, please contact J R Joshi at [phone] ext. 363.
Sincerely,
for Alan W. Klimek, P.E.
Enclosures (General Permit AWG100000)
cc: (Certificate of Coverage only for all cCs)
�Wilrrungton,R_egionai Office; Water--ali Quty.Seetion�
Duplin County Health Department
Duplin County Soil and Water Conservation District
Permit File AWS310567
NDPU Files

Type of Visit-k)C'ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q<outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
At fty
Date of Visit: Arrival Time: Departure Time: County:
Farm Name:, �/ L Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: .�
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: 0 c 0 t 0 I, Longitude: = ° = ` = "
III Design
WIN
Current Design
Current
Design @arrent
Swine Capacity
P,ogpulatin.. ,. WetltryutiaCapact ty.,Populat"on
Cattle;',Y Capri Population
❑ an to Finish
❑ Layer
❑ Daia Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Neifei
❑ Farrow to Wean
/3
Dry Poultry
❑ Da Cow
Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
I
I
umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ 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
0 I
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E N
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — % Date of Inspection G
a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Pio ❑ 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
r
Identifier:
Spillway?:
Designed Freeboard (in): Z 1 .
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 &
❑ 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 PNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o
RN
❑ NA [INE
(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 ;;ilo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �Xo
❑ NA ❑ NE
maintenance/improvement?
11'. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;2'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
/
❑ PAN ❑ PAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil /
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
%
12. Crop type(s)
13. Soil type(s) AA11.1//1 , lfi,C7`., _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 011
/
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Ye�
18. Is there a lack of properly operating waste application equipment? ❑ Ya
Reviewer/Inspector Name
Reviewer/Inspector Signature:

Facility Number: — Date of Inspection
T033—
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [,1No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 0No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste "Transfers ❑ 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
V'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
WNA
❑ 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
�io
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�Ko
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
Other Issues
epXt
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
;:JVo
❑ 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
P110
❑ 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 No
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
! No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

L
Visit Compliance inspection O Operation Review O lagoon Evaluation
for Visit ''Routine O Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number S �-7 "ate or visit: S Twine: � �{ '( S
Q Not O erational Q Below Threshold
',dPermittj{J Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
FarmName: ........................................._...........................---•------........................... County: __ QUPLzf'. ..._. � ........_ ....._
Owner Name: _.......................... ... Phone No: ......... .
MailingAddress: .... . ..................._.................................. ................. ............... ......... _....... .................... ........... _.............
Facilitv Contact: .............................. ...................... —_...._-Title: ...... Phone No:
Onsite Representative:Illit....�j� ...�� -- _-_-•- egra
v...._.r.......................... tor: .—... . ... .................................................... ........
Certified Operator: . ................ ................ ....... ­..' . .. . .. . . .......... . .... . ... I .................... I ........ Operator Certification Number: ...... ....................... .... ....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude ' C 96
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
j p
Ej Farrow to Finish
Gilts
Boars
Discharees & Stream Imaacks
1. Is any discharge observed from any part of the operation? ❑ Yes INO
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)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from; a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _....._.............. .......... - ..... — .. ___ .. ...................
Freeboard (inches): IQL_7
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes o
❑ Yes
❑ Yes No
Structure 6
12112103 Continued

Facility Number: — ] Date of Inspection 5 d
,V
/No
5. P.re there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
0 Yes
❑ 0
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes��No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type GEaz,M0o6) Cr SCrC)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
ZIN
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yes
o
0
16. Is there a lack of adequate waste application equipment?
❑ Yes
Odor Issues
/No
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Idno
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
No
Air Quality representative immediately.
�Comra�ts (refer to question #) Eaptaan anry�YFS auoswers a d/or agy recammendataons or any ati�erfcominents. r: �'
Use drawings f f �tybetter?explausr oirs{use addrdoual pies as necessary) Field ❑ Final Notesr
CARm 6?_E c.,oQ_DS C)
Ca %J v� Celt OF C1 s s �vE [2 6lj ✓=-F� �iy S•
Reviewer/Inspector Name = V � X—A
r . V .�'l-
ReviewerAkspector Signature: Date: LI [ S L
12112103 Continued

Facility Number: 3 — S'� Date of Inspection ! O
Rcguired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes23.
jNo
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ElYesVNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
r
(ie/ discharge, freeboard problems, over application)
❑ Yes
21 9.1
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
o '
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

s0 .
Type of Visit 'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 93 DZ Time: 17 O Q
Facility Number 3 S fJ
O Not Operational Q Below Threshold
0 Permitted 13 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name•. ... County: - V --........... -•--•--•--•--•---
....,.................................•---..........................._....... ..-•-------------
Owner Name:.---- r ra f �-�- Fa pD� t- T�L---------------- Phone No: _---- ---------- ----- ---------------
Mailing Address:
Facility Contact: ....... -..-• ..............................................Title: ....................: Phone No:
i
Onsite Representative: T�_ 5715 }y-o�tl';� ----- Integrator: __G h rre1--�----------------- --
Certified Operator:
Location of Farm:
......... ............. I ............. -.............. Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & OK Longitude • 6 �u
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
arrow to Feeder
i 3SU
❑ Farrow to Finish
❑ Gilts
❑ Boars
- Desig:
Non -Layer
=, I❑ Other
arrest Design Current
iUlatton ` Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
., se Subsurface Drains Prent J10 Lagoon Area ILI Spray Field Area
❑ No Liquid Waste Management System
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
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? Oyes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )�!(No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...... ..._ r-•--•--•--•--....-•--•--•--•-----•--•---- ........ .......... ..... -•--•--•--•--•--•--•---..............................
Freeboard (inches):
A!/A7/Ay
AG'/'"."L�:k`.L.ATJii57'Zi.T.'.'%fY7"GT.Ys:..:C:b'..�5'.ti-..ni..1,Y,fll:^:S�%.]S4'"x.CKYC�:}'.SCry._^.Trvr_-+.--re..:

UNU31vl
1?cility Number: 3I
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 Agmlication
10. Are there any buffers that need maintenance/improvement?
t,unrrnueu
❑ Yes )YNo
❑ Yes ONO
❑ Yes ff No
❑ Yes �No
❑ Yes ONO
❑ Yes j2rNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONO
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,O'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONO
b) Does the facility need a wettable acre determination? ❑ Yes J2(No
c) This facility is pended for a wettable acre determination? ❑ Yes Q'f o
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 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? (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?
❑ Yes 2rNo
❑ Yes �No
❑ Yes ❑ No
❑ Yes )Z'No
XYes ❑ No
❑ Yes 2 No
❑ Yes '[ 'No
❑ Yes'Ql Io
❑ Yes 0Na
❑ Yes ❑ No
❑ Yes El"No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
s'a" e r1to- ram=.�..._r ..,
Comments refer°to°question 'E9Explaman 'YES ansfvers and/or an recommendationsror. an o her:comments:.:.
i wings of�Iac Iity o b tier e�xpr alh s tuations addifional;p� becessary):
(use ❑Field Copy ❑Final Notes
- -- -- .
IUg ener'T t
`
2-00A �q✓, l !'l��,OO✓C
fir`!. Need -f� See Sin -,.vier 24d2 a�� 11`e'44-'en rccerdls. 00v 4kc =��—Z'S
FDA 5►J+^4,Vhef 2�Od1�-f'rQw� cTi�ne �a �� crnbe✓) Gt L../c Tt2 final yt,V
Z, is heir, LIjedi T1,e,�e ►s na Gd.�cs ,��'�`'� Grr?Gt(�lis ;h AC y` I^ no4eba0k
�4ke
Viewed Ste"'-F•me✓ `ZODZ otaO�O�iCc34"'-✓Verso' _.5 M-4 41'� 'EVVL"n`s
aft'; = V )eLJL'p{ �hc 2, r-� W�S� �lh�,l ys; s G{fcl of Tv1 ZDOI ®Brp�n'S O{Fr'GP.
,
T
Reviewer/Ins ector Name Q���,`%zs `F
p r.t� y �. �. �4�_-
Reviewer/InspectorSignature: Date: Z3 p

Facility Number: Date of Inspection 29 L
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29, is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31, Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes .:I No
❑ Yes gNo
❑ Yes ZNo
❑ Yes 2 No
❑ Yes Q No
❑ Yes ❑ No
Additional Comments and/or Drawings:.
star 6ee'A 4 /C4 e7,r WAS4C as 06✓41h-11ori,- ve*11 �
5A_ 7,,C live I Ie4�i j GlGi1'0Ccn� `fa Ich G�4 Ll�s
Ae 1,041,11, TL1Eyee )'r no V)'J IIC QvideLoll ce
4e, -4('d�c�, 44e 6es4 I co�tM see. Need 4,o Ir. a1v
�+ cfrq�4 01;• vevtf 40 )0fe-JePi4 1egL and i✓7S4MII Gnrt4,q;wncy+f�USI�_
/V e4C . Deed to re I a bG 1 s,
05103101

Dwision of Water. usii "s
Q Mston of Soil and Water Conser
vation
Q Other Agency
M.
Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit )Voutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number late of Visit: IJ1/ 'fine: y -�J Printed on: 10/26/2000
Q Not Operational Q Below Threshold
*ermitted © Certi d [3 Conditionally Certified © Registered Date Last Operate Above Threshold
4�
Farm Name: ....................Gt.VYv �..... 5....................1.............................................. County:...... ... rl% ...!.�. `:................. .:....
Owner Name:
....... Phone No:
FacilityContact:.............................................................................. Title:................................................................
Phone No:...................................................
MailingAddress: .................
......
...................J�............................................
....................................
............... ............. ................. ......... ..........................
Onsite Representative:.....��.....t
........................................................
Integrator:.................:..y.l......j-1............. ........................
Certified Operator:,,,,,,,,,,,,,,,,,, ............................................................. Operator Certification Number:
Location of Farm:
Swine ❑ Poultry []Cattle []Horse Latitude • 4 1; Longitude • 1 �
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity population Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
ow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area
❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste ;Management System
Discharges & Stream Impact.
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. II' discharge is observed. what is the estimated flow in gal/min`?
d. Does discharge bvpass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes WNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes A No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Idcnti fier:.........-.7....��67-0 ............ ..........
.................................
Freeboard (inches):
5100
Continued on back

] 6cuity'Number: — Date of Inspection E
Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures obse ed . (ie/ trees, severe erosion, ❑Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ANO
(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 ONO
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ),kN- o
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 maintenancelimprovement? ❑ Yes No
11. Is there evidence of over appiication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes to
o
14. a) Does thefacility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes q<No
c) This facility is pended for a wettable acre determination? ❑ YesAELNo
15. Does the receiving crop need improvement? /Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes J;4�N�
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ANo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ,Ilo
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 ONO
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes §`No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes PLNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �'�+IO
24. Does facility require a follow-up visit by same agency? ❑ Yes VNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
�%•yiOJbi ris-oi defcie cues were pgtt'ci diri°ing�his;visiti Yoit wits lreceiye;i}o fUttiter
- . • coo*e 6riden& about this visit.
Comments_(refer to.question #) _°Explain any,YES answvers and/or auuy recoq nendatiotts orL'any other coma ;
Use drawings of facility to:better_expiain situations (uEse additional pages as >necessarry)=
45
4W
yQ/s lDDT �WA
Ay A
Reviewer/Inspector Name % �Y � � r _ __ _ _ _ _ _ ' . q.•a: � �`'��� _
Reviewer/Inspector Signature: 9V_ j jj Date: S ./,-/( 5100

Facility Number: o Date of Inspection j Printed on: 10/26/2000
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments an or Drawin
gs...
❑ Yes ,® No
❑ Yes )}Vo
❑ Yes /
❑ Yes P No
❑ Yes PLNo
❑ Yes IONO
❑ Yes 1p No
J
5100

ka
i QaDIAs 6 of Sail an
I]rvision of Seiil an
l.c
w 3i ion of WateA qt
ate
on
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-uR of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted ❑ Certified 0 Conditionally Certified E3 Registered Not O erational Date Last Operated:
FarmName: ..............L ]r'5............. ... �.�......_.._................................................ County: .............Le?.-P-.1.O ..................... .......................
OwnerName:........... ..................................................................................... Phone No:.......................................................................................
Facility Contact: Dazzif .......... ... ...Title:........ Y/ .. ........... Phone No: ...................................................
MailingAddress:............................................................
6
Onsite Representative:...... / ,�IJYGL.... Integrator:... ...........................................
Certified Operator:.................................................:.............................................................. Operator Certification Number:
Location of Farm:
Latitude 0 4 " Longitude • ° 46
Design -• Current
,Swine -Capacity Pouulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder
3.
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current ;<Desigii Current
Poultry Ca acity..;Po ulation ' Cattle :. Ca pail --Pa-iirlation
1❑ Layer ❑Dairy
E] Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity;=,.
Total 7$SLW .;
-- Number of Lagoons ❑Subsurface Drains Present ©Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ANo
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 ycs, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than.from a discharge? ❑ YesNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes UNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: V r�
Freeboard (inches): ..........�....................
5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ANo
Continued on back

Facility`Nurp eeW Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes JNo
(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?'
Ayes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes VNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes J�rNo
11 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes gNo
12. Crop type
13. Do the receiving crops with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes MNo
14, a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ONO
c) This "facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes `Eg�xo
16. Is there a lack of adequate waste application equipment?
❑ Yes ANo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes [�No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes $3No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes qNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes j7No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes RNo
24. Does facility require a follow-up visit by same agency? [-]Yes � No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �o
Rio-violafi6ris of deficiencies mere potted during this 'visit. Moir ;will receive iio lruttho -
corresvondenke: about. this visit • :..• ..• . • ... • ...................... . .
_
Commentsv(refer to questions#) 'Ext laiti any Y_ES,answers and/or any recommendations or any `other comments: F'
Use drawings of facili17
ty to better,;explain.srtuations (use aaet oval pa es as necessary)
e -
{ Ytll"
� S awe i >2
C� 7 f—t°PL .3F (7-
w- 471�11
Reviewer/Inspector Name F
Reviewer/Inspector Signaturer-0 Ld ,r Z�f Date: 6 — 4 � __ J

Faculty Number: 31 — Si 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 �10
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [�f-No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes EJ.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 UNo
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 E No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes PNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes EANo
ae-
o
s
-- SOP
�/ Pf
` C� ��
�►"b �-LN�
Ul r�5rri1/t11�-f'�•-.�, i CLl ��'� l'�~
�!
�
wi Ll CJCGL L,
_ A

Water Quality Active Lagoon Rankling
Dra ca
Lo_
Central Office Criteria
1. Was facility constructed before 1993 MRCS Standards or there is no verification of standard?
?_ Plant Available Nitrogen (PAN) Deficit < 300 4! per year or FI_ F3 or F4 Wettable Acre Determination
Flaas
F1 Lack of Acreage resulted in over application in last two years
F3 Obvious field limitations ditches, buffers irregular shape
F4 Application acreage in excess of 75% of total acreage
3. Lagoon Capacity greater than 1-000.000 cubic feet
4. Was there a discharge from waste system in last five vears?
Central Office Criteria available after new verified GIS data is gathered from field GPS units
5. Distance from Lagoon to dater of the State (WOS) > 300'?
6. Is lagoon in 100 vear flood plain?
Field Inspector Criteria
7�vlodif�- Question ; 4 from current inspection_ add choice box: Is high freeboard due to storm -,eater or
management? r 2 2. I 11
SI. lodif}- Question l',from current inspection form (take immediate out) and define in form instructions:
Current question: Are there immediate threats to the integrity of any of the structures observed? (trees,
erosion) T
6dd question on effective embankment Height > 10-
e
213100

6:s/25/2080
Faoifity Number
15:28 919-715-6048
DWQ NON DISCHARGE BR
31 —,6Z�-7 Lagoon Number -------- Lagoon Identifier
6r,w�5 PAGE 02/03
Active 0Inactive
Waste Last Added
Determined by:
6l —
[]Owner ❑ Estimated
Dry �0-f � C r�"lZ,-p - ;q (a -s
Latitude 3r{ s2 EEO
Longitude Ei og pg
By GPS or Map? GPS ❑ Map
GPS file number: I WO & 6� S
Surface Area (acres): -.--- ..._..
Embankment Height (feet):p�"
Distance to Stream: 0 <250 feet $K�250 feet- 1000 feet 0 >1000 feet
By measurement or Map? ❑ Field Measurement j- Map
Down gradient well within 250 feet? O Yes I No
Intervening Stream?
Distance to WS or HOW (miles):
Overtopping from Outside Waters?
Constructed before 1993 NRCS Standards?
No verification of, adherence to 1993 NRCS Standards?
Was groundwater encountered during construction?
Depth to Groundwater:
Discharge within last 5 years?
Within 100 year floodplain?
Immediate threat to the integrity of the structure?
O Yes KNo
0c5
05-10 0(>10
O Yes
�0 0 Unknown
O Yes'
O No
Q Yes
'No
O Yes
O No
O Yes No
0 Yes No
O Yes No
Spillway 0 Yes No Adequate Marker P—yes O No
r�
Freeboard & Storm Storage Requirement (inches): ...... -------Z
33 5-1
K "

13 Division of Soil and Watei -Conservation--Operation.Review
- . � © Division of Soil and -Water Conservation ,Compliance Inspection - -
0Diyisiqu of Water, Quality Compliance Inspection
Y. _ _
- 3 Other Agency.-Operation=Re .view.
w
'Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 Date of Inspection 7
Time of Inspection 24 hr. (hh:mm)
Permitted oCertified © Conditionally Certified 13 Registered [3 Not O erational Date Last O erated:
Farm Name:__...GAPaLL�..........................�.�...... County'.....�.............................
...................... y
OwnerName: ........................................ . Phone No: .......................................................................................
Facility Contact: .............................................................................. Title................................................................ Phone No:......---- ..................................
.
'failing Address:
`c_f1�h CaGZA E! Alh Q P
Onsite Representative:- .............................................................9.i�t�,� Integrator:......�:�.ls..r.. �.. ................
............. .... .... ..........................
Certified Operator: ............................................................................................................... Operator Certification Number:..........................................
Location of Farm:
Latitude a ° Longitude • 4 66
.., _ :urrenDesign Current
' Design CurrentesignCCa e CapaciP.opulahon .Caacity Population PoSwineCapacity tyPo ulation ..
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
f �a
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�Number'of Lagoons ❑Subsurface Drains Present ❑ I agoon Area ❑ Spray Field Area
HoldingPonds / Solid Traps - ❑ No Liquid Waste Management System r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 11110
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made? ❑ Yes ONO
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes gNo
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 PfNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ "No
Waste Collection & Treatment ✓
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [Ao
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .......... Q...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes J�YNo
seepage, etc.)
3123/99 Continued on back

r f
Facility Number: r — '7 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
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 A ligation
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
7 za
13. Do the receiving crops differ with those designated it e 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?
I& 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/ irrigafflon, freeboard, waste analysis & soil sdtnple reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0. �cio•yio�latfi6iis:or• deficiencies •*ere potted• dirrhig this:visit: You wiiI-receive d further:
:: coriesparidence. abavti this visit.
❑ Yes O No
❑ Yes ONO
❑ Yes /No
❑ Yes eNo
❑ Yes f?fNo
❑ Yes jzfNo
❑ Yes No
❑ Yes No
LZ Yes ❑ No
❑ Yes Z No
❑ Yes [ONo
❑ Yes t2 No
❑ Yes ONO
❑ Yes ZNo
❑ Yes _2'No
❑ Yes .,�?No
❑ Yes 2rNo
[]Yes ,e No
❑ Yes No
❑ Yes21'No
❑ Yes �No
Commenis'(refer to_ question`#): Explain any YFS answers and/or any recommendations or:any other comments
Vse4rawings of facilityto=better explain situations (use"aAaitional-pages as necessary) `
Dt �e-vt S's,� r� � ue4.E, %R£. A �a C P{�-�z- � �reu C. A2S-`� �'a i i�z,,L•�, � �J ti.�.P IFS PialC�j � _ �
t S� ! /L A Jac La HfE I-S �#£ �k Lr /✓Fr 1<- =" r-A RZ, C Yts S To to ran r Nr M 4
OWE F"td-10 9A_ s A, VE-4J f C-L-C* P'4-�q- i 4g" t& d fj 'Tides .D i_�_ err
,4 p�`l£s<-Sr`3�J !� e'A-t µ Mr`�,lr`.N�Zf o-,r-;F-'+JTI A-L PLv{d+3\J,f r4 4- TR1/>cL LA+_
Tlli S QA SFt4u1-D Q {�}u�El) 5t.cN 'r4tiKIT �iAs`E i.li LL �� a£- i QQ.`�ATED cieJa-a
6At?L$-- 05 S1.a
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 7,8
3/23199

t
Facility Number: 31 —.Sb'�- Date of lnspertion
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below PYes ❑ 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 PNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ 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 40No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? _Yes ❑ No
3/23/99

0 Division of Soil and Water Conservation [3 Other Agency
® Division of Water Quality
Routine 0 Complaint 0 Follo=u of DWQ ins ection 0 Follow-up of DSWC review 0 Other
Date of inspection SJIZ
Facility Number 31 � '1
Time of Inspection � 24 hr. (hh:mm)
E3 Registered 03 Certified 19 Applied for Permit 13 Permitted 113 Not Operational 1 Date Last Operated:
FarmName: .........z:4.`.1.............................................. 1- .... I—.......... ---- County: .......b4ttr........................................ .......................
Owner Name: ........... Cmat.mw.,.... R
rg ............................... .. Phone No: `�rd� Z93- 3 3¢
........................................... ...... ............. ................................................
Facility Contact: --.,,, ....... � Title: . Phone No:
::...................................
f
MailingAddress:...... �.a...�4.X...,...tn......................................................................... ....................................................... -AM ..........
Onsite Representative: ......... S..ail...... ci3.killw............................................... I................. Integrator: .........axn-A.........................................................
Certified Operator:............................................................................................................... Operator Certification Number ......... .............
Location of Farm:
..................50r....Zt.....W....11,02..................... a ....... 9'.I!.o................................................................................................. i
........ ... ........ ................... ...................................... ...
Latitude Longitude
;Design "Current Design ;Current -, Desrgn Current
EZ„Somme .,;, Capacity Population Poultry ,Capacity. Population ... Cattle. _Capacity: Popuilatian ,
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
13SZ
❑ Farrow to Finish
❑ Gilts
❑ Boars
J❑ Non -Layer
�' ❑Other
V L
General
1. Are there any buffers that need maintenance/improvement? ❑ 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 lagoons/holding ponds) require
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes]
No
❑ Yes
No
❑ Yes
No
❑ Yes
[P No
❑ Yes
No
1A Yes
❑ No
❑ Yes [P No
❑ Yes tp No
Continued on back

'[Pacilitv Number: 3j —,ST,:j
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaLmons.11olding Ponds, Flush Pits,sie.,
9. Is storage capacity (freeboard plus storm storage) less than adequate?
I
Structure I Structure 2 Structure 3 ,Structure 4
0 Yes 59 No
C1 Yes El No
Structure 5 Structure 6
Identifier: . ......
Freeboard(ft): .......... Z5 ................. .................................... ................................... .................................... .................................... .................................
10, Is seepage observed from any of the structures'? D Yes M No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? D Yes No
1
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers" El Yes No
Waste Application
14. Is there physical evidence of over application? 0 Yes No
(if in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ............ 6V,-U,� G............................................ 5 ftl( ............. .................. ................................... ............ ....... .....................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWIMP)? E]Yes R No
17. Does , the facility have a lack of adequate acreage for land application? ❑ Yes -&No
-, C�
18. Does the receiving crop need improvement? Yes El No
19. Is there a lack of available waste application equipment? C1 Yes P No
20. Does facility require a follow-up visit by same agency? El Yes 04 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? El Yes N) No
22. Does record keeping need improvement? El Yes DO No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit" C1 Yes No
0No.violations or deficiencie's w'ere-no'te'd-during this.'visit. You_w'ill receive no further
correspondence ahoitit -this. visit'.,'.
Comtniihts,(riferlo question#):, Explain any YES answers and/or atber comments A any recommendations,orl�py,,p
Usedrawin gs of facility'to better explain situations. (use additional pages as necessw rv)
NO 13 5kA 6 x1es)tJ w4k 6owJa, Errisic­ o-tic" t f, A-eld *5-
1Z_ 0"5zrjh W0,09 br, yl\nx-/ OVA.r �"4 Wa of I&IDA A-Ibj ;j*_ J 11
rc.-.e�. g"V C,rc % S"A bW_ RStedf_j 4
7125/97
Reviewer/Inspector Name g
Reviewer/Inspector Signature:— Date:

<�, .� . - -: _ .T .. •- �� " �R N,��x�; - --:-ram _ '. -�..-�,�'�,.••. r; -- - �_. r' - m I
� w 6.
=- �.� r � C1DSWC_ m i. ee �Operatlon Review
ni a �lo
{
AnimaITee dlot Ope�atibn Site Inspection
® Routine Q Complaint O Follow-up of DWO inspection O Follo«'-ua of DSWC review O Other
Date of Inspection °k 7
Faciiity dumber
Time of Inspection I is; Lc' Use 24 hr. time
Farm Status: c i r1 _ Total Time (in hours) Spent onReview
or Inspection (includes travel and processing)
Farm Name: County:.
Owner Name: C ry VCO& (-n • _ Phone No:Lq4. _ZE.- Iza'
Mailing Address: 17 ,.}
Onsite Representative: _ 1. lb a r I-SQ0 Integrator:.-
Certified Operator: !vi_ _._ M ._ _� _ Operator Certification Number:1�I_.._. ^--
Location of Farm:
Latitude ' ©a U Longitude ?if 0$ t 1L J �'
Not Uperarional Date Last Operated:
T�-pe of Operation and Design Capacity
Swine _'- � t:� G =•-: -� .,M.
..:.Number-, Poultrv=
... \umberSCattie . i4umber
❑ Wezn to Feede- ❑ Lave: Y ❑ Dairy
❑ Feed.—,. to Finish ' ❑ �Fon-LaverI ❑ $eef
Farrow to wean
Farrow to Feeder =r _
jEj Farrow to Finish w ❑ Other Type of Livesiock '
=� 1lumbt r oC Laaoaris / i3aldtng Ponds: '" ❑ Subsurface Drains Present
' t z,a y,.e jF�,,cx�t-sazs.t�.a� %w - r a:3 a• a" _ p -
tv--.w7' .=?r.:zx.„... rr�`.?,a�.-�' '?:-•:'�r.'s5`"^c �? x ?`°�:,,,-s:o".; ,.. ❑ Laggoon Area ❑ Spray Field Area
General
I. Are there any buffers that need maintenance/improvement? ❑'Yes No
2. Is any disc: arae observed from any part of the operation? ❑ Yes No
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (Ifyes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gai!min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes ®i\o
Is there evidence of past discharge from any part of the operation? ❑ Yes m No
4. Was there ary adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other'than lagoons/holding ponds) require ❑ Yes ® No
trainte :anc:. improvement?

6. Is facility not in compliance with any applicable setback criteria? ❑ Yes [� No -
7. Did the facility fail to have a certified operator in responsible charge (if inspection after I/l/97)? ❑ Yes ® No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Ji No
Structures (Lagoons and/or Hoidin- Ponds)
l
9. Is structural freeboard less than adequate? ❑ Yes ® No
Freeboard (ft): Lagoon 1 La_oon 2 Lagoon 3 Lagoon 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/unprovement?
(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 adquate markers to identify start and stop pumping levels?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or =oti entering waters of the State, notify DWQ)
15. Crop type-r e„u�r.
16. Do the active crops differ with those desi4nated in the Animal Waste Manaaernent Plan?
17. Does the facility have a lack of adequate acreage for land application?.
18. Does the cover crop need improvement?
19. Is there a lack of available irrintioa equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did ReviewerlIaspector fail to discuss review/inspection with owner or operator in char-ge?
❑ Yes
(2 No
❑ Yes
No
Yes
❑ No
❑ Yes
No
❑ Yes
®Na
❑ Yes
B No
❑ Yes
R No
❑ Yes
O No
❑ Yes
E \o
❑ Yes [Z No
❑ Yes J� No
❑ Yes IS No
❑ Yes 6d No
❑ Yes 0 No
Comments (refer to guestton �) Ecpiain any YFS answers and/or anyYecommendattons or any oel comments
Lise draws "s uif fac�ta to better`e Iatn sttuattons . use.addmonal a es asnecessar� � : y �. «��� � ,. -�•
LTX �+� Z YtPeJ �c �� rZ5 L201C• t�IrL'S ipt L4ks Lii �V� `�111ie D �L{Zf eN �S �L�1�1 +�' 4
�c. ��IRiJ Lrn'!fl {`C.S2C��LT.
Reviewer/inspector dame'
Reviwer/Inspector Signature:
Date:
cc: Division of dater Quality, Water Quality Section, Facility Assessment Unit 1 1114/96

Site Requires Immediate Attention:
�. Facility No; 3 r s`b -7
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8' F , 1995
Time: It. a_ `' .
Farm Name/Owns
Mailing Address:
County:
Integrator: r Ar-(-J)� -- Phone:
On Site Representative: o �-- �c 7 Pr ._ Phone: ft0 51'42 L 3 cl 0
Physical Address/Location: IIC s /L _ 4_z off_ &,heu)44,Y+p C_ t�2 � _ _ — a y
Type of Operation: Swine.Poultry Cattle
Design Capacity: r��, it, 1:e-9ANumber of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 1 \-( ° 5'1 ' a 9 " Longitude: 6 V' " 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? (D or No Is the cover crop adequate? Oe-or No
Crop(s) being utilized: -/d / bPE
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.
Additional Comments: e
•
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

•; tr u�cui, I+- rb. L-Plk du S�uw rsk
Site Requires Immediate Attention:
Facility No. 31- J! k
. DMSION OF ENVIRONMENTAL MANAGEMENT ty At�
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
3� % Z5 1
DATE: Y 1995 -£
Time: t 3 l
Farm Name/Owner: %-L--5 OF oaf -Z 1 4 %
Mailing Address: o ;?- A
County: e;W
Integrator: f o o o=S F ALA s-S... Phone: Q[ i oo
On Site Representative: Dm� Phone: 5 t o
Physical Address/Location: - -- -
Type of Operation: Swine X Poultry Cattle
Design Capacity: 13 -�o Number of Animals on Site: 1350
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
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} Ye or No
•s as any seepage observed from the a oon{s}?
Is adequate land available for spray? QYS:s_0 No
Crop(s) being utilized: t�_
Actual Freeboard:--,S Ft. Inches
Yes Was any erosion ob rved? Yes or�
Is the -rover crop adequate? Yes r No
Fol
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwe�lin s? Yes
100 Feet from Wells? Yes or o
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:
No
Is -animal waste discharged into r of the state by man-made ditch, flushing system, or other
similar man-made devices? Ye or No If Yes, Please Explain.
Does the facility maintain adequate waste management reco volumes of manure, land applied,
spray irrigated on specific acreage with cover�c+rol; Yes r No
Additional Comments: '� �k ` `^ { r4 --tp
f' %CH1kr,L
Oispector Name ,
Signature
cc: Facility Assessment Unit Use Attachments if Needed.
Yes or�