310605_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Q-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: & xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access t ;
r w
Date of Visit: Arrival Time: - ft 0 I Departure Time: o` County: (ice Region: wi
Farm Name: �j�d S Owner Email:'
RECEIVEDINGDENR/M f
Owner Name: �p � �Gc1.'� ��� (t A�'� Phone: �J
Mailing Address: AUG 17 2017
Physical Address:
r Operations Section
Facility Contact: 2L'j ttt'<-tf Title: pl%apngton Regional Office
Onsite Representative. (( Integrator: "'L 3
Certified Operator: () �111c J�44-5 `_1 Certification Number: 9'" 7 05
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
Design Current
Design
Current
Design Current
Capacity op.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
FSwine
Wean to Finish
Layer
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
p
airy Heifer
row to Wean
Design
Current
D Cow
row to Feeder
©, l;oul
Ca aei
P,o
Non -Dairy
to Finish
La ers
Beef Stocker
s
Non -La ers
Beef Feeder
LFarrow
rs
Pullets
Beef Brood Cow
Turke s
er
TurkePouits
er
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [ oor ❑ NA ❑ NE
[:]Yes [—]No fn NA ❑ NE
[] Yes ❑ No L_I NA ❑ NE
❑ Yes ❑ No
❑ Yes EEINo
❑ Yes No
NA ❑ NI?
❑ NA ❑ NE
❑NA ❑NE
Page -1 of 3 21412015 Continued

Facih Number: Al - Date of Inspection: -/.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [j_Nv---0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No E3'9_A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard(in): q,S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑-15 ❑ 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
E31�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑-1 l-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
E]_�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): H � P SIii o Cwg
13. Soil Type(s): — — - — 81- ao (0 1> C­'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[T No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E2 f' o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ /No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [J No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
21. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes D No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
❑Yes ❑No DNA ❑NE
[:]Yes [—]No
❑ Yes ❑ No
[:]Yes ❑ No
C9- 7.t( -P--7J(
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
UL PhoneJA
�]U 33.3335�
Date:
21412015

Factty Number,' 3 C7
I�
ivision of Water -Quality
Dwision of;Soil and Water Conservation
0 Other Agency, -
Type of Visit ,Cr-compliance inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit_<�Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I {0 7I(.# Arrival Time: . (3C] Departure Time: County: Region: W fa
Farm Name: �y ��� �6� / fir,, l- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
On site Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ` = 11 Longitude: = ° =, = «
Design Current `De,
Swme
Capacrty Population Wet Paultry , Cad
R
❑ Wean to Finish
, ❑ La er
ElWean to Feeder
Non -Layer
❑ Feeder to Finish
-,,2, ❑ Farrow to Wean
;Dry Poultry ,
❑ Farrow.to Feeder
r El Farrow to Finish
El Layers
❑ Gilts
❑ Non -Layers
❑Boars
" ElPullets
❑ Turkeys
Other
- . ❑ Turkey Po ults
7 ❑ Other
._ ❑ Other
;77-
n Current
it} Populahon _ �,�Cattle "~°��
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
El Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood C
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? I
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes�No
❑ NA ❑ NE
❑ Yes ZfNo
❑ NA ❑ NE
El NA ❑ NE
❑ Yes Ja,_No
❑ Yes E(No
❑ NA ❑ NE
❑ Yes �No
❑ NA ❑ NE
Page 1 of 3 12128104 Continued

I
Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[7TNo
❑ NA
❑ NE
f ' ' a. If yes, is waste level into the structural freeboard?
❑ Yes
�6No
❑ NA
D 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
12 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E� 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
[—,I No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Excessive Ponding O 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 ff No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �fNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ff No [] NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes d No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E � No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑%No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
21412014 Continued

FaciHty Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes jffNo
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ONO
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 ;;TNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes �TNo
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? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to que"stion,#) Explain an' E answers and/or any additronalarecornmendations or.any ©ther comments x; �
Use drawings,of;facilrty-to;tiette°explaEn situafions(use additional pales as necessary) „;<., ,, •e.: r
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[DNA ❑NE
❑ Yes ONO ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes PTNo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
/v/3 0//s` a - q3 - &'-'r
Reviewer/Inspector Name: ��! i h (/�2•i/ L � Phone: /'07��
Reviewer/Inspector Signature: 1 Date:
Page 3 of 3 214120I5

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine Q Complaint O Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Phone:
Phone:
Integrator: &'n
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity 0Pop.
Wean to Finish I ILayer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I jNon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D , P■oul Ca aci P,o ,
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
[ither Turkey Puuets
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
[:]Yes
Ga'No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facilit Number: - Date of Inspection: 4 /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes allo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2No ❑ NA -ONE
(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
�TNo
❑ 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
allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
ZYes
❑ No
❑ NA
❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
1 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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
[:I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Tel No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C2'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
_E;�No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
21 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
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 21412015 Continued

[Facility Number: -,3 jDate of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
No ❑ NA ❑ NE
tke 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
PNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes
PyNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
I 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
❑,No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes
0No ❑ 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
P'No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
J—/No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
I �{ o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
I �J 110 ❑ 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 eaplam situations (use additionalpagesas.necessary).-
�' o� rG��• �„r hOc� 1 C -its SV
y o� c1Uyy--e_ --0
S �-o i� v mF fit~ �� i k
-�(
w� A ha•tis 1 \,.j c �Vaj c},,. e �-� , lees
dd�t�SS 1 �5 Sv Y\0 WC 5� ��awS Ivxkt
- 0\0 UJ � � S� d P �- G ICJ --A Vk � CSC-\
r
p t�� � 1 �Scx�Y• 1���.1 � G�,S �Q��1� z t rti, 1
WA
Vt coy, tY�- 5,ock
Reviewer/Inspector Name: /40, hVPhone: T
Reviewer/Inspector Signature: Date: O7 1.
Page 3 of 3 21412014

F")
ivtsion aQ4W ter Quahty
Q Devtseon of Soil and Water Conservation
w�
Facrtlrty:Number 3 ]
.
„Other Agency a
Fzo
Type of Visit Ptompliance Inspection 0 Operation Review 0 Structure Evaluation . 0 Technical Assistance
' Reason for Visit,,6 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Ito Arrival TiDeparture Time: f .� ounty: � Region:
Farm Name: vlel
ocnOwner Email:
Owner Name:
Mailing Address:
.Physical Address:
Facility Contact: ��, n I-Q ✓1 ill C Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:_ �t 7
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ p ❑ Longitude: ❑ ° = , = fl
Design Current Design
Swine _ Capacity Population Wet Poultry lEap"gelPu
„W _
❑ Wean to Finish ❑ Layer
❑Wean to Feeder " ❑ Non -Layer
rrente
nation Cattle
❑
Feeder to Finish
'-
❑
Farrow to Wean
"
❑
Farrow to Feeder-
El Layers
❑
Gilts
Boars
Other
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
i LJ Dairy Cow
❑ Dairy Calf
❑ Dai
kry Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
w ❑ Beef Brood
Discharyes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes ONo
i LJ Dairy Cow
❑ Dairy Calf
❑ Dai
kry Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
w ❑ Beef Brood
Discharyes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes ONo
❑ NA
❑ NE
❑ Yes ZNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes P No
❑ Yes fffNo
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

II .
Facility Number: - Q . Date of Inspection: b
Waste Collection & Treatment
4. Is storaga capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ❑ No ❑ NA ❑ NE
(G/
0
a. If yes, is waste level into the structural freeboard? Oyes ❑ 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 0 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 10 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 environMgptal 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA Z NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA,,o 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
eNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
ZfNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
aNE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
,,eTNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
[�J'NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[TNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
EfNE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21, Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
❑ No
❑ NA
�NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No.
❑ NA
0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
[DNA
ONE
Page 2 of 3
21412014 Continued

►/
Facili Number: - G Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑ No ❑ NA 0 NE
[:]Yes [] No ❑ NA f2rNE
❑ Yes ❑ No ❑ NA ['NE
❑ Yes IoNo ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ONE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes �ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No 2�NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? /Eyes ❑ No ❑ NA ❑ NE
Comments f refer to. question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better exalain situations (use additional pages as necessary).
�reeb6G�d � 8 "
1�o� 4�_ repii�ed,
Reviewer/Inspector Name:
Reviewer/Inspector Signature: A/ —
Page 3 of 3
Phone:
Date: G
2 4/20I

Type of Visit: Mcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: RrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: l County: �� Region: j. AA
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Certified Operator: Gh&_AE, AAy,.,,,-,
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number: 1 ! f
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La ez
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
l Ca aci. Plo ,
ILayers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other I
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

- 5-1
JF`acity Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VrNo
❑ 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 0"No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes �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 partof 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 J?fNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ,. 0 Heavy Metals
❑ 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 Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZN0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [;r4o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes LZNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ZNo
❑ 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 ZNo
❑ 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 PrNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VrNo
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

acili ' Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes eNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes KNo ❑ 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 Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [2rNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes ZNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes eNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes ONo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes PTNo ❑ 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 (ease additional pages as.necessarO.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L*
Phone: , I —Old%
Date:
214120I4

i
type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit;
Arrival Timer
Departure Time: .'
County:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region:
Onsite Representative: Integrator:
Certified Operator: C VN't h% _ Certification Number: ] r? 9Tq
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current Design Current
Design
C►urrent
Swine C►apacity
Pop. Wet Poultry Capacity Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
[Non -Layer
DairyCow
Wean to Feeder
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Dr, P,oult , C•_a aci_ P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
jPullets
Beef Brood Cow
Turkeys
her
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
[:]Yes
a No
❑ NA
❑ NE
[:]Yes
ONo
❑ NA
❑ NE
Page I of 3 21412011 Continued

i 4
Facility Number: - -6013 jDate of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2TNo ❑ 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 2INo ❑ 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 E21No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VrNo ❑ 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 '0JONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes j2'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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 ff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes PffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes tZeNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes P�r`No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes eNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Pno
❑ 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 J21'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �io
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

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

(Type of Visit: Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit.Routine 0 Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit:J-1 ArrivalTime:w= Departure Time: County: Region:
Farm Name � T'T 5 ZWId501/ 1-�O (Z �j9 cR N` Owner Email:
Owner Name: C-�v5 + � A7 k1'gy(_ j Phone:
Mailing Address: ILL 1t V�G�C-AVs�- Ac 'W'56
Physical Address:
Facility Contact:
Title:
Onsite Representative: �c)wj 64wl r� �_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Wean to Feeder Non -La er
Cattle
Dairy Cow
Design C•arrent
Capacity Pop.
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Eurrent
D r P,ouI Ca aci Pao
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Finish
ILayers.
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes �kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ro
NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: ,4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes j No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes TT❑'' No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ NA
❑ NE
❑ Yes
No
[:]Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 'k
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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 Q❑ Application Outside o(ff Approved Area
12. Crop TYpe(s): (� aw "C-4T S9 V�_��t J `l cas CiAC
13. Soil Type(s): W GlTl1l cJlUI Li V- CaOCC >545c4LCj MLC-'SiO
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
6No
❑ 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
[3 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP []Checklists ❑Design Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
�] Waste Application Q Weekly Freeboard Q Waste Analysis [] Soil Analysis
❑ aste Trans ers
0 Weather Code
0 Rainfall ❑ Stocking Q Crop Yield E] 120 Minute Inspections Q Monthly and V Rainfa 1 Inspections
Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
Paige 2 of 3
21412011 Continued

Facility Number: jDate of Inspection:
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 77❑ 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, aver -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
O."No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes �No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes DRf 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).
CAL-,?c�-,J )CW
D(D. gc-ED �F °c�C�� Glc cR W% r2CdcZDS-LA
cam c� G3]N►5 �-c M,4kE
ay
5LX C:IC_ ACCDOC-_
W.4.
3/4,QL /� �
4141 M3
' , ?�
�D C
Reviewer/Inspector Name: 4A MW 0 Phone: 1(0_43'0
Reviewer/Inspector Signature: Date: 5/A -
Page 3 of 3 21412011

Type of Visit: ACompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: %_Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: E,Lt-z�.------1 Departure Time: County:Region:
Farm Name: [-E5 )47 K j nrSW fb,&, VjWM Owner Email: —
Owner Name: _ (��-C-�S E , 4 j 1LIN 3CW Phone:
Mailing Address: _+�_S CCaW 11 1 !LC_ RJ VJ E UUI¢ V 1(_-L E
Physical Address:
Facility Contact:
Title:
Onsite Representative: VC4kk u. Smi tt Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacii MWattle-11111
La er DairV Cow
Design C►urrent
apacity Pop.
UOUS
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Dairy Heifer
Design Current Dry Cow
D , P,oul Ca achy P,o Non -Dairy
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non —Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
ether
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Lk No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

144'eiG Number: 60S Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5_�>
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.) �kNo
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ NA ❑NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
AM
7. Do any of the structures need maintenance or improvement? Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? Yes No' ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes *No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable CropWindow❑ Evidence of WindDrift ❑ Application Outside of Approved Area
\
12. Crop Type(s): (, `j �' C� } `�-SCi�� J4 1� .
13. Soil Type(s): nLITEi Ui [ L {2 C)S
14. Do the receiving crops differ from tose designated in the CAWMP?
❑ Yes
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
[:]Yes
0 No
❑ NA
❑ NE
acres determination?
77777��
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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes%No
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists 0 Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes PNo
❑ Waste Application 0 Weekly Freeboard Q Waste Analysis ❑ Soil Analysis ❑ Yste "transfers
Q Rainfall ❑ Stocking Q Crop Yield 0120 Minute Inspections 0 Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N0
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

F26ili Number: jDate of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes kNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Ayes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
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:
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes O"No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes kNo
o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes ❑NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yeso ❑ 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). - �*
f7 God oG I l bZ L c�Q� �c-t j Cod c+c
d1GU
rJOA1 �u� (0k 1
(&.s . l4
913/0 1-D
r
pit_ DA-reZN a/L4/11 I s (-d�- '/o Fo9- �!
- IWo S Ar�� S GF}LLFo(� M4� TyA�c/ o2T OF C_ilwG �k' �rST G�L� -OiL fkQ(L�
14 lT - LaoK_ tAt L1 ME Foik P10LZS
Reviewer/Inspector Name:
ReviewertInspector Signature:
Page 3 of 3
�r S►'k��� rR-f.�5 oG� a � �-�Gocw D 1 r-�
Phone: 9%G --3q4'-_43 r
Date: tL 1
21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 411outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: LI N Region:
Farm Name: 14a�ZLZ—S [!T1e,//V SQ/ MC FgaM Owner Email: n rya
Owner Name: C W-C-F-S F. AT r-oysCoy Phone: �(���i—
Mailing Address: � I SILL F-L� l-C-P0IfLr yOR
S)
RJ)�
Physical Address:
Facility Contact:
Title:
Onsite Representative: 111 LLF-g &4W/EiL
Certified Operator: s K1N -q3.V
Back-up Operator:
Phone No:
Integrator: `� �q
Operator CeQrtiification Number: f+ `y f
Back-up Certification Number:
Location of Farm: Latitude: 0 c = 6 = « Longitude: = c = g 0
Is
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑Wean to Finish
Layer
Dairy
❑
Cow
❑ ❑
❑ Non -Layer ❑ Dair Calf
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El 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 �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
12/28/04 Continued
I

Facility Number:
Date of Inspection S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (A6CCrV
❑ Yes �No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA [I NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freehoard (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 El NA El 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 fXNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes ANo ❑ 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 Drii+ [IApplication Outside of Area
12. Crop type(s) � ``
9-14 W NC-Z-9 PT —in ) J G L` C 5 c c&E
13. Soil type(s)
J
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
VjNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XVo
❑ NA
❑ NE
D ES DIAL* X�uQom b\\CE_ w ,4
ReviewerlInspector Name p f f T ;S ^X ; Phone:
Reviewer/Inspector Signature: Date: y
Page 2 of 3 12128104 Continued

Facility Number: 3 ( —(CGS Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ❑ No
❑ NA
XNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ANo
❑ NA
❑ NE
the appropriate box. 0 WUP 0 Checklists El Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Xo
ElNA
❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ kste Transfers ❑)annual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield [] 120 Minute Inspections [l Monthly and 1"
Rain Inspectio'nnss.,/ []
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
- 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes V No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
XNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ANo
❑ 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 4 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Addrtibnal,Commertts aud/or,Drawings �" T�`'willili
Iti1 �
•
�11� �•�
F•i 6�', Ncc� u rv\C
f
FA LL_
12128104

.,,,fir.,-.. ,... ..-•a,-;�-�-. _
Type of Visit WCompliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint 0 follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: �j crI Arrival Time: ® Departure Time: County: QAf Region:
Farm Name: _ CN (��� 1`tT �M Owner Email:
Owner Name 2lE_—K1/vScvc/ Phone:g1�-�/��p�-SQa�
Mailing Address: $ S C-07W f 'M t,(x e(�'
Physical Address:
Facility Contact: ``- Title:
Onsite Representative:F�• �N�E�1 .JDHiViV�1 i FWIE2
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =1 o [:] [ = Longitude: [= ° = g = it
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
IEJ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
FZ Feeder to Finish
L/c
Dairy Heifer
El Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ ❑ Beef Stocker
[3 Gilts
-L
Non -Layers
ona ers ❑ Beef Feeder
❑ ❑ Pullets Beef Brood Co
❑ Turke s
❑ Boars
Other
❑ Turke Poults
❑ Other
❑ Other Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes )ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
l,�Lj No
❑ NA
❑ NE
12128104 Continued

•L�
Facility Number: 1 — &S
Date of Inspection Es=
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )XNo ❑ 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: LAcnog
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yeso ❑ NA El NE
through a waste management or closure plan? AN
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? A 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 KNo ❑ 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
KNo ❑ NA
❑ NE
❑ Excessive Ponding ElHydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
l
[]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 El Application Outside of Area
12.
Crop type(s) CC M (�.F RL] �2 (P\-1 _ _ 'DC-b PG-5 CUC- 6�
13.
Soil type(s) _ !QU I _LA U 1 C L E �cx_flS P�a�C� _T�1� r�5 7 _QA/ l`ft4 1 fz"
01 LLF
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
KNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
0 No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
o ❑ NA
El NE
17.
Does the facility lack adequate acreage for land application? El Yes
jNo.ElNA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ElYeso
❑ NA
❑ NE
c ='%t z ' >aa "^. € - - .w wu;iR n°&.�'rw�g "s5wi - '"r�;,r,-
;Comments (refer to question #)' E�pla�n any YES"answers and/or anyrecommendattonsoranyother comments:
IJsedrawm srof faciii to better ex larn s�
E . sa
ty p tnafi0 5 (use addlfional pages a5 neCessary)%* .� 4
�. �
w.
1o'� ) -g
'i� 10q I to ► .4
n
Reviewer/inspector Name S �� Phone: g �� `,TG(-' 30�
Reviewer/Inspector Signature: Date:�1 _
Page 2 of 3 12128104 Continued

Facility Number: ] — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )�No ❑ NA ❑ NE
the appropirate box. 0 W"Up 0 Checklists 0 ❑ Design Maps
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
0 Waste Application El Weekly Freeboard [3Waste Analysis ❑ Soil Analysis ❑ 4Yaste Transfers ❑/nnual Certification
0 Rainfall E] Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and V Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
gNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
X No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
O NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
` No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
KNo
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VfNo
❑ NA
❑ NE
.. .. ..J w hx8 -^x,,, G,,. �.u'":s'�iS,� ^°»& ex. E«i �:n^"^ti'o »a ''Y.�
Adidiiiii : Comments and/or Drawings , _« s " . ..:a, .»� �.W., • Y* _ ;�. �t lg 00
'FR-orv_ C-4tWoonl c,.'�A trL ,q"S A p
V30`-�)A/ CW /iV S[ DE w A-U-
1
G 9 S Coca ��. � - ON �11C� w�LL
o � 'd 9 o C-
QI Q1c, r--.,;> aGj )vG
Page 3 of 3 12128104

II
Division of Water Quality
Facility Number O Division of Soil and Water Conservation
Q Other Agency
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: (D� fT Arrival Time: '5� Departure Time: County:
Farm Name:
Owner Name: pia Af��E � ) N501 i
Mailing Address:
Physical Address:
Facility Contact: Title:
`
Onsite Representative: �.�1:244AINL& L' N11: -�
Certified Operator: & C +�- . AT K-1 A! S CW
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Region
Operator Certification Number: 1 :h q q -!
Back-up Certification Number:
Latitude: = = i Longitude: [= ° [= l [= u
Design Current Design Current Design Current
*Sw� ` Capacity Population Wet Poultry Capacity Population Cattle Capacity Populati'o"
Wean to Finish
❑ Layer
Wean to Feeder
I I0 Non -Layer
Feeder to Finish
Farrow to Wean
Dry Poultry
LI Farrow to Feeder
❑ Farrow to Finish
JILT Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ 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?
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: y�
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 ANo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 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?
Structure l Structure 2 Structure 3 Structure 4
Identifier: 64GOOly
Spillway?: Q
Designed Freeboard (in): !. S
Observed Freeboard (in): 3
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 Q(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [&No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1� 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 IX No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance/improvement? ��,,//
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El 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
l2. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JS(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1� No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ 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):
F+Rot& J A <500� 5 t}�C
N EEtN i C> Mom
[ill S 1 bE d F*b IKG w A"-
Reviewer/inspector Name I Hal 4 Phone: 7K-)_ t7(0` f_.)
Reviewer/Inspector Signature: Date: 3
Page 2 of 3 12178104 Continued

Facility Number: — Q Date of Inspection �Ia
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ 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
gNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JX No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
AN o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
4 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
INo
❑ NA
ElNE
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
J�'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
qNo
❑ NA
❑ NE
Page 3 of 3 12128104

0
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
--- �- 0 Other Agency
Type of Visit 0 Compliance Inspection O 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: 1p Arrival Time: ' S Departure Time: ; County:
Region:
F rm Name: Owner Email:
Aw"neP Nsme: 4-c46 6,4c y d ram. 444825a^2 - Phone: p �� Z�S
Mailing Address: 3 zzL eo" `/� ' �3
Physical Address:
�,Eu ufiyzLc- E � C Zr`35l �
Facility Contact: tgf_ T_ =k QAa Title: Phone No:
�Oflt/��n7
Onsite Representative
--Z�IAIWZ Dmle Integrator:iQPi�/.�(BRocrJr1J
Certified Operator: A50/1& .Pr �soP-) Operator Certification Number: y_ 2g 170
Back-up Operator:
Location of Farm:
Design Current .
Swine Capacity Population
10 Wean to Finish
❑ Wean to Feeder
Feeder to Finish 20 foO
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 4 = Longitude: = ° = 1 = fl
Design Current
Wet Poultry Capacity Population
FLayer
Non -Layer t
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 ;ffNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes ;dNo
❑ NA ❑ NE
❑ Yes XNo
❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection I OZ I
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
Strup e I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) 10
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,ETNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,rNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/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 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind
�,D_rift 1❑ ApplicationK
side of A a
12. Crop type(s) t�, 4, zw/.'1'l660 A- f V'." I 6. (�, �Sf�L� /CSC , /�."
13. Soil type(s)
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes ZNo
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ YesXNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Plo
❑ 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: D Wb — 3Z
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 op No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes to
❑ NA El NE
the appropirate box. ❑ WUP [I Checklists El Design ❑ Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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
❑ NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes ❑ No
'El
NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes ❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
WNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes iQ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes / No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes )ZNo
❑ 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 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
IC2
12178104

gracility Number (,Ds
L9 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ,Coompliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit V� Routine o Complaint Q Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: yS Departure Time: County: Lir/FC Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: CNAlLC 1 4114L )S0A1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: E--] c =' E__1 Longitude: =° [= 4 = 4i
Design Current: Design Chrrenta Designs Current
Swore Capacity Population. Wet Poultry Capacity Population Cattle -Capacitya Po ulatiao
❑ Wean to Finish
❑ La er
El Wean to Feeder;
❑ Non -Layer
® Feeder to Finish
V U
Dry Poultry
❑ Farrow to Wean
❑ Farrow to Feeder
ers
❑ Layers
Farrow to Finish
❑ Non -Layers
ElGilts
❑Pullets
ElBoars
❑ Other
❑ Turke Poults
- - —
❑Other
Discharges & Stream lm2acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
�r
Number of Structures
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes D4 ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El Yes
VXo ❑ NA
El NE
El Yes
L"J No ❑ NA
❑ NE
12128104 Continued

Facility Number: ' — 8 ' Date of Inspection
--�r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure/I Structure 2 Structure 3 Structure 4
Identifier: _ (A 6-60 N
Spillway?: 4
Designed Freeboard (in): 15�
Observed Freeboard (in): 2�
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 OeNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [J"No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes L7 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E_ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes O No . ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidenceoof Wind Drift ElApplication Outside of Area
l
12. Crop type(s) ( �,� ,S �D CW3 1 L-6--)1.
r
13. Soiltype(s) AbTrzY1E-t& C7rr�aA.a rAe_ST& /
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2'No ❑ NA ❑ NE
L"J No ❑ NA ❑ NE
Efj�lo E IN A10 NE
I No ❑ NA ❑ NE
LJ 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):
v?,O.4TE JK9- 1
1i' m &I-; Ta PP Q__CWIT . -r22Z Ceti &CTF.
Reviewer/Inspector Name 1
/� �'� Phone: /If— 3 Ll
Reviewer/Inspector Signature:
Date: 6 oZ{a D G
Page 2 of 3 I2128104 ` Continued

1. Facility Number: — QS Date of Inspection
v
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo
❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Ch kl ❑ D ' ❑ M ❑ Oth
ec tsts 'sign aps er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
M/Yes
❑ No
❑ NA
❑ NE
Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
PT'Waste Application ❑ Weekly FreeboarV120
❑ Annual Certification
❑ Rainfall ❑ Stocking❑ Cro Yield Minute Ins ections ❑ Monthly and I"
PP
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
��
LI No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Dl o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[2'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
dNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,.,s�
LNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[34
❑ 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
,/
P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
���
EI o
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

[A
rU."A
Type of Visit GfCo Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ; 4-{J Departure Time: County: �'�►� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: CaAtztfes ATK-ENS°N`Integrator:
Certified Operator:
Back-up Operator:
Location of farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c ='
= Longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish
V.14 z.o
g p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: �I
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 VINO El NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes Z No ❑ NA ❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
12128104 Continued

Facifitjrj�iumber: —�yoj` Date of Inspection t zZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes UIo ❑ 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: LP6oat�1
Spillway?:
Designed Freeboard (in): e1 S
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
Ef No ❑ NA ❑ NE
through a waste management or closure plan?
t, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaZo
7. Do any of the structures need maintenance or improvement? El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
No [I NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes.
Flo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElL
Yes
, _,
ilo ❑ NA ❑ NE
maintenance/improvement?
It. 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 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) i3Eit-ywyoA (_6 ) S 6J ccscuc ( Cr) CAS
13. Soil type(s)
to
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
�7NJD
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
[:I NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
' ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E No El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
At,� uA 9o.TE: c n-o f `(.SE L4�0
W U p t)3 D ta'T-C-_ D wLA-IA NC W u L-L-j ra -o rr. �9-<� V.r. o U'S �E AiL -f SQ e C I -3..W
Reviewer/Inspector Name �Gl 1>,ll��t�, -1 Phone: (q) O)
Reviewer/Inspector Signature: ,PM,. Date: t
12128104 Continued

Facilit�,Number: 31 — `oS Date of Inspection ; z
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ We-
ElEly Freeboard El Waste Analysis El Soil Analysis [I Waste Transfers El 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes E2 No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
[2�To
El NA
El NE
El Yes
��o
❑ NA
❑ NE
❑ Yes
❑ No
A
El NE
El Yes
El2 No
DER
NA
❑ NE
❑ Yes
DNo
❑ NA
❑ NE
❑ Yes
❑ No
E NA
❑ NE
❑ Yes
LI'No
❑ NA
[I NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
E] No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: �.
12128104

Type of Visit 0 Coyhpliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number (00 Date of Visit: Z v Tune: 73 a
Q Not O rational Q Below Threshold
Permitted Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _ ._. A ' IZ'il County: OV P I--rr
OwnerName: �» ... ..._ .....___W_ .. »....... .. _.. .. Phone No:.. �.. _. .. _.
kfailing Address:
Facility Contact: Phone No:
Onsite Representative:? P 171�s aN-j - - - - - .. M. Integrator: CA
Certified Operator: _ Operator Certification Number:
Location of Farm:
© Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • " Longitude • '
Eftchwmes & Stream Irnvacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [:]No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes L;J No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes E21 o
Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facility Mimber: a Date of Inspection
5. 4e. there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes No
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 maintenancefimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenanmprovement? ❑ Yes d'Ro
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �To
elevation markings?
Waste Avolication
10. Are there any buffers that need maintenancelimprovernent? ❑ Yes 0p
11. Is there evidence of over application? if yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type rtso)e L0 1360-bnunp, C6-)- • - - -
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes uwo�
14. a) Does the facility lack adequate acreage for land application? ❑ Yes �o
b) Does the facility need a wettable acre determination? ❑Yes 10
c) •This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? es ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ yes
Air Quality representative immediately.
❑ Feld Copy ❑ Final Notes
2.3 .-) N E W u P wS-T H Vzf- Las ? wi-S D o t V_ ACXC 0P -P =,J6-T6
5H- �^`' V S-TTr4Er=7r L -vj R QL)_-X kr"r,4s,
posssr�►-E N�orc �Lt;c. a�Er�-wR� DOE i� '0s=SV, WING PEe- Fuu/.,
r OYLAT� S d S�"TM i 6ftntr /} �tj-c O Cf`A F t ZST IJ:r-T R IJE W fn�l , W l �l✓
��� wvf 06r��y n�ovE aLQ fAAPs APE)
Reviewer/Inspector
Date: 'a
12112f03
Con#nued

Facility Number: 31 v
Date of Inspection 29 0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑/Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes[INo
❑1Yes O No
L�J Yes ❑ No
❑ Yes VNo
❑ Yes
❑ Yes zo
0
Yes
❑ Yes 311o'
❑ Yes B-N o
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes [:]No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit /9Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit iRoubne O Complaint O Foilow up O Emergency Notification O Other ❑ Denied Access
71Facitity Number Date. of Visit: Time:
10 Not Operational 0 Below Threshold
Permitted O Certified 13 Conditionally Certified [3-Registered
Date Last Operated Bove Threshold:
Farm Name: ......... ... County:..._ -1 ......... _--- _----- ----- ___ _--
Owner Name: ........... .. 5�-rz;QszN._.._............... Phone No:
Mailing Address: .................... ..................... ..........
FacilityContact: ..........Title:........................................................... Phone No:...................................................
I �
Onsite Representative:....._.. ,�i�f�1......7 .... Integrator: ......
Certified Operator ....................................... _ .. -.- ._... Operator Certification Number:.........................................
Location of Farm:
;2(5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 Longitude • 6
Lean to Feeder
'Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field �i 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 galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2- Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......... .......................... .......... _....... _............... _.
109
Freeboard(inches): ........� ............... ................................ .................................... ................................... ...........
❑ Yes ❑ No
❑ Yes E2rNo
E] Yes XNo
Yeso
Structure

Facility' Number: — Date of inspection
5. Are there any immediate threats to the integrity of anz• of the su-ucnures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑Yes o
T
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-"oses an
El Yes/No
immediate public health or environmental threat, notthl• DWQ)
7. Do any of the slructur= need maintenance/irnprovement?
❑ Yes R(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
J Yes ZZNo
9. Do any stuctures lack adequate, ganged markers with required mammum and mmimum liquid level
elevation markings? , ;
❑ Yes X No
Waste Application
` '
10. Are there any buffers that need maintenancefun*vement?
❑ Yes No ,
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ By aulic Overload
Yes No
12. Crop type
244��
13. Do the receiving crops di&r with these designated in 6, Certified Animal Waste ent Plan AWMP}?
'
El es No
14. a) Does the facility lack adequate. acreage for land application? �✓
❑ YesXNo
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pcnded for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop Ineed improvement?
Yes ❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes /No
Required Records & Documents Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El1 Yes }� No
/
18. Does the facility fail to have all components ofthe Certified Animal Waste Management Plan readily available?
❑ Yes eNo
(iet WUP, checklists, design, maps, etc.}
19. Does record keeping need improvement? (ie/ irrigation, freeboard waste analysis & soil sample reports)
❑ Yes No
_ 20. Is facilitymot in compliance with any applicable setback criteria in effect at the time of design?
L] Yes No
.21.. Did the facility fiE to -have a actively certified operator.in charge? r
❑ Yes �No
_2. Fail to notifyiegionalDWQ of emergency.siuiations as required by General Permit?
(ie/ dischargr; freeboard problems, over.application) 0-Yes No
23. Did Reviewer/insgector.fail to discuss reviewhuspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes
No
25. Were any. additional problems noted which cause noncompliance of the Certified AWMP? _ _0 Yes T
Noviohrtionsor:ileficiencieswere:ooteddutting#]xisvisit. You-mllreceivenofitrther-correspondence:aboutthisvisit.,

Facility Number: —
Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
E
❑ Yes No
ElYes ��� �No
❑ Yes ,�o
❑ Yes 6 No
❑ Yes o
ElYes Yes/No
❑ Yes ❑ No
Addition�a/]'Comments andior'Drawings
-T;Dry �rl%D� iIJ7
G� Rk
'A"I 1%N�iiiG
Nip o
r� � � l"
�J DLf/1 kne
[A)P- :
05103101

Type of Visit compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit-.eRoutine O Complaint, O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number j d 5 Date of Visit: M � Time: Z = DD
Not O erational 0 Below Threshold
© Permitted 0 Certified 0 C�ornditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: .. G�......................................................... � C.k?*evo/'A...�Lmy�..L:..�ir ...:�..................... County: t1]O,r•'r•...............................................W
OwnerName:..........`'.¢1........IVK,.'nSt�!'!.............................................. Phone No: .................................... ......_.....................
FacilityContact: ............................................................................--- Title:................................................................ Phone No: ................... ..................... __
Mailing Address: ......................... ...................
Onsite Representative:. ....................... l kL✓Zs�'� Integrator: - !e4i ......_..
m................................ ....
Certified Operator: ................................................... ............................................................. Operator Certification Number: ...................... ... ............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �Du
Design Current
wine Capacity .. Po ulatrou-.PoWtry [
_
Wean to Feeder
Feeder to Finish
_0
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
go, -: Current Design;
city,.'Population Cattle .Capacity..
Other
. Total Design: Capacity
Tota1:SSLW
x Number of Lagoons ❑ Subsurface Drains Present ❑ Lagooa Area ❑ Spray Field Area°
Lag ,
Holding Ponds /-Solid Traps: ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 'ONo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, 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 ;31No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............1.............................................................................................................. ......................._.
Freeboard (inches):
5100 Continued on back

)C-Acility Number: ) — Q S Date of Inspection Q �
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes "ONo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes JdNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,QfNo
11. Is there evidence of over application? ❑ Excessive Pa�o--n--ding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONo
12. Crop type C oV1rL , k) h ak t e t l-s, re fGya Fa S4 t/ rf , r r''' vd(� >Q®l.S v�e� �yv��.i r G` c �-•
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Yes [:]No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ONo
16. Is there a lack of adequate waste application equipment? ❑ Yes 'kno
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes - P1110
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.EfNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ,j3Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes AErNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes -Mo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes_'ETNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ,BNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes,4!fNo
4. MOrA0jns Air 0010000ps were n0ed• 00t #9 011S W; •Yoh will-treetriye too fuI.
cories deuce: about this visit
Camtextts (refer to question #) Eitplatn any YFS answers and/cjr aQy recommeudat'tona or any other comments. s r�
Use'da of faciii to better taint situations. use addttlo�al es as nec
wings. b' (_ pa. ►ry)
2. T1keYe is -Sa►-ie Uo4-4e a4 44e low end eLF ��te IZoreses-fah,_ee
A-�k��sa�, S•t y s saw Qf 4 to -rle " wcv4; %) oc4-} saes ;n4o C1-ackt
1Y1 41,%e `✓ork1...l" f't -!ice k7o_oe. And A; Sckm jes ctt1 B�r A,,, -1 vnr'e1
/
7tteScheed 40 bla g4ACGr 4U pYeve4i pi i SG�1Q�"ge �i�c r houses
1�,F, -TtiG gcr�a�e show, 6� sev"e>-a1 oP 41,e ZKXJ 2►.5 #&4,we -11W7 4W
aceea,ge J, s ed i yN 4e I,vas-/6 P14,,7. --rh e CAee-% Aeedl a we4,4ble gcleS
, rexared (4p be k-elPac��d�'
Reviewer/Inspector Name,,
Reviewer/Inspector Signature: Date: i Z$ Vho smo

t.
Fac' Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of property within 24 hours? ❑ Yes_XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J�fNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes,,O No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes'VNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
-Adctitionall Comments:an or' rawings:�,
E�. �..Orj� ��'• r7T�C �vti1'OH .Sq,1..� S ��9'' � `' (R�.6�'-? CA.�� OLG�` � �i(� SOr�'ie
�
�n fY -��i,► r�� b��� ��.
Need �O -�;►-4 a�a s4a4 vs anal e1 L3,,,ale 7e, es
13. -r4e w,,xle ,pian des;�r�.�es �l�l �'� esGve. ►'�� �k�",tea►►
Y14S d �a/' SPr;� ''"� �er'r,.✓dam,, h7eed �a .3P';�
�r��Gt��d
be,� m-,� �C� spa �.v ► v1.�' eq, f 1 7 sfri nq —Q Z Gr3 s v re
�o i 1 �G S'�'
�S. li?eed �o � ��' 1 � r�C Bn sQve�^al �'i 2 �d.s a c�o-�d r•� td
r'e e,ev,.t me a 1 e1d S C 411 �q �Ce v- 44A4G a rt e
Ion a-,- ^n-e e -e rc b," atcfe v, p -n a COA
19. Se,iGral ��'��S ��w GI,G✓'6-°.�� t-.i�,~G�i G�eG'S 7�,0� GDf',/'�5��
4,9 wex.14o r1 ti n CSee 1 � , G•^or ve �' ✓)eedi Ao -1
,.��ee;e
ro w' V-V'4 . C"Oewe'- -needs 40 Slow 4cl v
S Af 1►'ca4J
e � �d
�eg2 S. �r e ,e�' �1n g �d dam
q j� 41g�1 �'G�i� i 0;1 I-eC S �O f�ow LLB S Vea"!'�� Ga`I f'Oh a-�' �1Le
ayt.l7 00 I
rl ee�1 i-a key l tieeP Agee
�'�lT 3
A. n aL %ee A 11 reGDrd� - ,/ I2sj
stow 41-ug4 Ge, Z11— OV Pe ir)
Li 1 CA�T'on r�Go�dJ
srleeA 4a k sure Ge��1 AM a46t'I"a4e,
be�"1-_s
o ,
/ �/�
J8- �e7 4O t- i11 OK4 ;—sec-4#1 Arta r—e I14ee'1 d1ek k1isvV,
5/00

Facility Number 31 605 Date of Visit: 11-28-2001 Time: 12:00
Q Not Operational O Below Threshold
® Permitted ® Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: . __ __ __ __ __ _.
Farm Name: ChAjr19.$.Atkinaou H!og1Earm................................................. County: 11mWin .................................... RM......
Owner Name: Charles_---- ----------- Aticigsiw--------------------- ---- Phone No: 9Jk-_29$:.5228---------------- ------------
Mailing Address: I ,5....Qrj1. Jl.ad ............................... ............................ Z8518 ..............
Facility Contact: ........................................................... Title: .............................. Phone No:
.......................................................
Onsite Representative: �Jlar�CS.lil11TQA---------------------------.-.---- Integrator: �arr9�1' h4�si�a--------------------_..
Certified Operator: Ch7tr.I.eS..lam............................. Ad u s.Q11.......................................... Operator Certification Number:1.79S.P ............................
Location of Farm:
South of Beulaville. On South side of SR 1724, 0.2 miles East of SR 1962.. +
® Swine ❑ Poultry ❑ Cattle [3 Horse Latitude 34 • 52 i 27 Longitude 77 • 47 50
Design Current
Swine C30aeitV Population
❑ Wean to Feeder
® Feeder to Finish
2420
[]Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I JE] Dairy
❑ Non -Layer I JE] Non -Dairy
❑ Other
Total Design Capacity 2,420
Total SSLW 1 326,700
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes N No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? N Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:------------- I ------------- -•------------•--•--•--•--•-.............................. -------------•--•----------
Freeboard (inches): 46

Facility Number: 31-605
Date of Inspection 11-28-Z00!
Uunnnuea
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
12. Crop type Com, Soybeans, Wheat Fescue (Graze) Coastal Bermuda (Graze) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? N Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? N Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
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 N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
N Yes ❑ No
❑ Yes ® No
❑ Yes N No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes N No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer�to ° uestion # Ex lam an Y>✓S answers and/or an `-recommendati
(._ q ) P _ Y _ _ . Y ons or any other comments
_ .
Use drawings -of facility tobetter explain -situations (use,addrtional pages as necessaiy) s� Field Copy ❑ Final Notes
77
2. There is some waste at the low end of the houses where Mr. Atkinson says some of the water from washing out goes into cracks in the
alkway in the house and discharges out of air tunnel. These cracks need to be patched to prevent discharge from houses.
14. The acreage shown on several of the RW's is more that the acreage listed in the waste plan. The farm needs a wettable acres
determination with a matching waste plan and records to be kept accordingly. Mr. Atkinson says Star Maready came out and did some
work but he has not received anything back yet. Need to find out status and get wettable acres ASAP.
13. The waste plan designates field 4 for Fescue. Mr. Atkinson has field prepared for sprigging Bermuda. Need to sprig Bermuda in
inter/early spring 2002 to ensure a good stand of Bermuda.
Reviewer/Ins ector Name Stonewall Mathis entered:b Bet
P Y to Rose ;:_
Reviewer/inspector Signature: Date:

05103101 Continued
Facility Number: 31-605 1Date of Inspection 11-28-2fl01
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not Iocated near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
[Add itionah_ ,omments an or,i)rawmgs:;;
15. Need to put lime on several fields according to soil test recommendations. Put on fields calling for one ton or more per acre but
do not exceed 1.5 tons/acre.
19. Several IRR2's show acreage wich does not correspond to waste plan (see #14). Grower needs to keep IRR-I forms. Grower
needs to show actual times of application on IRRI's and IRR2's. Grower needs to sign and date all application records to show his
verification of the information. Grower only has June thru August 2001 freeboard records. Needs to keep weekly freeboard records
and keep all records at least 3 years. The application records show that corn was applied to in April 2001, but Mr. Arkinson says the
applications were for soybeans. Need to be sure records are accurate.
18. Need to fill out insect and odor control checklist.

�.4
r !♦ .Divistda of Water Quality , = _ -
a m
QDivislau of Soil and Water Conservation _
-_ _QOther_Age©cy
(Type of Visit O. Compliance Inspection O Operation Review O Lagoon Evaluation j
for Visit OO Routine O Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number 31 b05 Date of Visit: 11-28-2001 Time: 12:04
Q Not Operational Q Below Threshold
® Permitted ® Certified 13 Conditionally Certified [] Registered Date Last Operated or Above Threshold:
Farm Name: G1tar.1fS.A,tkiaa010.kI.Qg.�.at'm................................................. County: Dxpliot.................................... kYJiD.Q......
Owner Name: Charles - Phone No: 9�Q$:��Z$----------------------------
Mailing Address: 7. .Gax>rt. i�liJ ,ua................................................••------•-------••--------. D.Cwpxlll�...!iQxtb�.GaxuliRa............................ Z8518
Facility Contact: ........................................................... Title- Phone No:
Onsite Representative: Integrator: '
p C.harJes.A�#kiasor.---------------------------------- ��rrszll�.�Q9si�.Inc----------------------•
Certified Operator:CjharleS.E..............................AUdm.Qu...................... ..................... Operator Certification Number: X.71&9.............
................
Location of Farm:
South of Beulaville. On South side of SR 1724, 0.2 miles East of SR 1962.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F 34 • 52 L 27 Longitude 77 ' 47 ° 50
Design Current
Swine C'anacity Pnnnlatinn
❑ Wean to Feeder
® Feeder to Finish
2420
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 2,420
Total SSLW: 326,700
Number of Lagoons 1 ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ®No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ® Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentifierI ------------- -•--•--•-----•- --•--•--•--•--•------------•---•--•--------•--•--•--•------------------•--•-----••
Freeboard (incites): 46

v�ivaiu�
Facility Number: 31-605
Date of inspection 11-2$-2001
Lunrinueu
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ®No
12. Crop type Corn, Soybeans, Wheat Fescue (Graze) Coastal Bermuda (Graze) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ® Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ® Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
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/lnspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comriients (refer #o.question #f) Explainrany Y>,S answers and/or any recommendatiods or -any other comments=;
Use drawings of facile#y #o better explain situations (use;additional pages as necessary) _- al Notes
Field Copy Final
2. There is some waste at the low end of the houses where Mr. Atkinson says some of the water from washing out goes into cracks in the
_
alkway in the house and discharges out of air tunnel. These cracks need to be patched to prevent discharge from houses.
14. The acreage shown on several of the 1RR2's is more that the acreage listed in the waste plan. The farm needs a wettable acres
determination with a matching waste plan and records to be kept accordingly. Mr. Atkinson says Star Maready came out and did some
work but he has not received anything back yet. Need to find out status and get wettable acres ASAP.
13. The waste plan designates field 4 for Fescue. Mr. Atkinson has field prepared for sprigging Bermuda. Need to sprig Bermuda in
winter/early spring 2002 to ensure a good stand of Bermuda.
Reviewer/inspector Name Stonewall Mathis =- entered' by Bette Rose _ -
Reviewer/Inspector Signature: Date:

05103101 Continued
Facility Number: 31-6U5 Date of inspection 11-28-2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes IN No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
A _ditfonal - omments and/or_ _rawings _-
15. Need to put lime on several fields according to soil test recommendations. Put on fields calling for one ton or more per acre but
do not exceed 1.5 tons/acre.
19. Several IRR2's show acreage wich does not correspond to waste plan (see #14). Grower needs to keep IRR-1 forms. Grower
needs to show actual times of application on IRR1's and IRR2's. Grower needs to sign and date all application records to show his
verification of the information. Grower only has June dim August 2001 freeboard records. Needs to keep weekly freeboard records
and keep all records at least 3 years. The application records show that corn was applied to in April 2001, but Mr. Arkinson says the
applications were for soybeans. Need to be sure records are accurate.
18. Need to fill out insect and odor control checklist.

f
i�
Date of Visit: 11-2$-2001 Time: 12:00
Facility Number 31 605
O Not Operational O Below Threshold
® Permitted ® Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold_ _ __ __ __ __ __ _.
Farm Name: G Ar1es.AWUSOAHQg.kArm................................................. County: DNSLliu....................................
Owner Name: Charles------------- - - AlUU%w------------------------- Phone No: 4J.Q-�4& .Z2$-------- ---------------------
Mailing Address: .7.$j5&.Qj[x1..0' jjjRAlld...................................................................... tiulayiJ<I...I!iQxth. a�abate............................ 2$518...... I ......
.
Facility Contact: ........................................................... Title: ........ Phone No: ...
Onsite Representative: Iar1gS.AstiililSQA---------------------------------- Integrator:C_arrAU'_Eo.9dsjj1&-_-------------------..
Certified Operator:Clttxrlt<5..E............................. Atl{ D,5. a.......................................... Operator Certification Number:1.7.9$9.............................
Location of Farm:
south of Beulaville. On South side of SR 1724, 0.2 miles East of SR 1462. A�
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude 77 ' 47 50 .1
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
® Feeder to Finish
2420
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer 1 10 Non -Dairy
❑ Other
Total Design Capacity' 2,420
Total SSLW 326,700
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area 111 Spray Field Area
Holding Ponds 1 Solid Traps JEJ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes M No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes [:]No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? M Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ------------- .--------------------------------------- .......................... -------....-..-----------..._----------------------_-...........................
Freeboard (inches): 46

VJ/uJ/VI
Facility Number: 31-505
Date of Inspection 11-2$-2001
,-unnnueu
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
12. Crop type Corn, Soybeans, Wheat Fescue (Graze) Coastal Bermuda (Graze) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ® Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ® Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
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 ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes M No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (defer to:gneshon #) gExplam-any YE3 answers and/or any recommendations or-any,other comments
Use drawings ofjacility to better explain situations (use'additional pages as necessary) Fr -
Field C opy ❑Final Notes
2. There is some waste at the low end of the houses where Mr. Atkinson says some of the water from washing out goes into cracks in the
walkway in the house and discharges out of air tunnel. These cracks need to be patched to prevent discharge from houses.
14. The acreage shown on several of the ERR2's is more that the acreage listed in the waste plan. The farm needs a wettable acres
determination with a matching waste plan and records to be kept accordingly. Mr. Atkinson says Star Maready came out and did some
work but he has not received anything back yet. Need to find out status and get wettable acres ASAP.
13. The waste plan designates field 4 for Fescue. Mr. Atkinson has field prepared for sprigging Bermuda. Need to sprig Bermuda in
inter/early spring 2002 to ensure a good stand of Bermuda.
Reviewer/Inspector Name Stonewall Mathis entered by Bette Rose - -- :-_
Reviewer/Inspector Signature: Date:

O5103101
Facility Number: 31-605
Date of Inspection 11-28-2001
Candivued
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes []No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ®No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
Additional ,Comments, an_ _or _Trawings, :.
15. Need to put lime on several fields according to soil test recommendations. Put on fields calling for one ton or more per acre but
do not exceed 1.5 tons/acre.
19. Several IRR2's show acreage wich does not correspond to waste plan (see #14). Grower needs to keep IRR-1 forms. Grower
Beds to show actual times of application on IRR1's and IRR2's. Grower needs to sign and date all application records to show his
verification of the information. Grower only has June thru August 2001 freeboard records. Needs to keep weekly freeboard records
and keep all records at least 3 years. The application records show that corn was applied to in April 2001, but Mr. Arkinson says the
pplications were for soybeans. Need to be sure records are accurate.
18. Need to fill out insect and odor control checklist.

�t Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit If Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit )WRoutine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Date of visit: Time: q = j S Printed on: 7/21/2000
Facility Number
0 Not O erational 0 Below Threshold
oPe emitted• SCertiried [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .............
Farm Name: G 1"`4l.'..1.c-3 A4k n-sOtt �r �ca.'.." ?........... County:.��U .i' �.?.......................................................
.............`` .......................
OwnerName: ...........0 hov-1e'.3.....L.'.IJ�.� � r0 ►-.................................................. Phone No:......................................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:................................................................................................................................................... ..........................
Onsite Representative: „611,q �.! es .........T3. K i....
i1So',..................................... Integrator:...C.�.r'!" ................................................
Certified Operator:, ...... Operator Certification Number;,,,,,,,,,,,,
Location of Farm:
`Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude •
&
1;
Longitude 0 ° �«
Design Current
Design
Current
Design Current
Swine Canacitv Pomilation Poultry
Ca aci
Population
Cattle Canacitv Po ulation
❑ Wean to Feeder
Feeder to Finish
Z420
f Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑'Gilts
❑ Boars
❑ Layer ❑Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I i I ❑ Subsurface Drains Present JF0 Lag—n Area ID 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?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............... I .................. .................................... ................................... .................................... .............................
.
Freeboard (inches):
5/00
❑ Yes 9No
❑ Yes gfNo
❑ Yes gjNo
.n Iq
❑ Yes ONO
❑ Yes fi�] No
❑ Yes 93 No
❑ Yes x No
Structure 6
Continued on back

Facilityk'umber:3� — �Q • Date of Inspection 1 00 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes ligNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ZYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ANo
Waste Application
10. Are there any buffers that need main tenance/improvement? ❑ Yes 79No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 25No
12. Crop type _Corn, wheql ,Soyheanz..ge-y'�,Ivdr, FRSJvrc,, S;m 11 ara;,, -S:_e5Cve F>e?S.Alre
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 0No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [:]No
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
violp .iotris;oi- & cie vies •were n6fed• during this;visit' • ;Y;oit will•reCeive iio i'urther; ; ;
... ...... .................. .....
corres�oridence: about: this visit. .
❑ Yes ❑ No
❑ Yes ❑ No
19 Yes ❑ No
[:]Yes Z No
$ryes ❑ No
Oyes ❑ No
Yes ❑ No
❑ Yes XNo
❑ Yes R�No
❑ Yes VJ No
❑ Yes F�2 No
❑ Yes 15No
❑ Yes 21 No
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):
A.
�l�rri'c�rheSt (.1e-
fveq��e)r/ e�C1. ! % / Hs
7C�pO►l�rO/ �e�G laA"e/Yi eP7 #h/le✓' -d 004,- l (�g40w twi Hs/� I )
S. Jee►),vVL,e 1'.�iiv))t�17��%Aak7b6rP'tL)401 qIA.CfCJI ` We9,4�-t -OrVN &er �`Lvpfq PpaS'ifires
F-iGlA Z b �iG�R T. +1 e+'neve Jet i�'lir�Jq,'�e weGIASge a, 1 Fe_ ss6oe Y1 J)vre r,,Gld 6.
i t T-e-sc v c Fa s 4 v ,-c i r` L%J a.0 e j't a tIVI :4;e 1 a( h 0kS n 0� yr� bea"
lavrlad 17-►irt, c rj.­, geldg 4 es b0js r Gr-v
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: B it O(% 5/00

Xacilitx Number: 3 / — CPOS Date of Inspection rr DD
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon' fail to discharge attor below
❑ Yes
B No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
'Pg 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?
gYes
❑ 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
M No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
19No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
gj Yes
❑ No
Additional.Comments an or rawings: -=-
Ixt
ate- 1 1 1 1
Ca�0WCy- ShgeeS ot ree- �j qVN t j�a`S So"eo�e Re- fVrQ 4),q-q'-/'L ,,s
-
dOE,t %,&% J-(CW Froi1 -eSS J011 Wq,f4e- r-VJq+�/19 Cr"-%eV)4. e1� lie2O� 70
/
ab�n)' . otn W his Otv, -, •
Jrl. cA,/e o f Ce ✓F1a9G 6 � nrea 1 �v .se'14
4-aa now-r' 6y ,Me /'� r�vRilabl�.
J �"hs e c-} of n d o d Q v C o ►� -} �^ o LI f c 1 r S s ►� end -Ja b e a b44' n cp4
Cow1f 6't t 5'�c'�e0� � Rn� ke�� l�i� �� neGord j
�t+naI r:� ne-eo( �o de kei'► MereE're9ven�I y J wals�e
I 0 G0ri ng w'4�t;n
As'lal�//1 r'J "qX, etn h-C 14 teii'
_
6�/tom s 61 zW e em lvkq tjsis. Az,-ea�ie ir)ow+� 01, _2's 1.x
y�l,atM �l �.as�r l4,1 GiGr��e s�u1d 6c slipr,.n c^� +�%�-z�
r►1o�e
As 4hue4 J1 s-� i� Rite ��t►7. �,npt,le� lle��s J/n ke��h�
�,CT . G nac,, e � N e ¢ 0�5 ->t-d I' V -� a �'I oa�a-� � e., d�v ; c c ®n sy s�-e►M �'� �4>� � �c
3/23/99

I
Division of Soil and Water, -onservation:- Operation•Review
°= w •[� Division of Soil andWatei Conser�at<on�- Coid fiance Inspection
Division of Water Quality Compliance Inspection L
�,Other.Agency Operatiotr:Review, = ,
Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other'
Facility Number (,p ` Date of Inspection G Q
Time of inspection 24 hr. (hh:mm)
© Permitted R Certified 13 Conditionally Certified 0 Registered �] Not O erational Date Last Operated:
[ E �, ` { P ........
Farm Name. .............. CA&ox��4g................ —iAVAV-N....... . .................................. County:.... .-Cx,, i....................---......-----.........................
Owner Name: ..........................t X lArILS. A.A,.-Rirlsofl,........ .............................. Phone No:.....���d�2a U .-.-SZT ....... .
Facility Contact:..............................---.......------.----................._......... Title:....
Mailing Address: 3. g$.....C:s?rt,....M.-k....... ...................
Onsite Representative :............0 !Y S........ml"nsn ...............
Certified Operator...... ..............................
Location of Farm-
1
Phone No:
........... .....I .. v1fkV&r..)....Wr...................................... 15.........
........... Integrator: ...........!f.Y..Q.lh..................................................
Operator Certification Number:
r...................................................................................... ---- •.. ............t J
Latitude Longitude
Design Current Design .. Current Design Current
Swine Capacity Po ulation Poultry =Capacity Population Cit -Capacity Population
❑ Wean to Feeder
Feeder to Finish
-Z4 Zn2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
�Nuber of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding.Ponds i Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed., did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Doe,, 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
Identifier:
`iiliii�, •
❑ Yes No
❑ Yes No
r
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Freeboard (inches): ..............:. iP...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.).
3/23199
a
...................................
❑ Yes �bNo
Continued on back

Facility Number: 3(—(ap$ 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 main ten atce/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
g No
❑ Yes
s❑ No
❑ Yes
O No
13. Do the receiving crops differ with tlrose designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Rio viol'si�tYoit wiil ceeeye Rduth ..........wnghis:visi; ey ; ;
corre 06fidehce. about this .visit. . . .
❑ Yes Pa No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
nYes ❑ No
❑ Yes ,M No
❑ Yes Ca No
® Yes ❑ No
Yes ❑ No
❑ Yes No
❑ Yes lj�j No
❑ Yes 0 No
❑ Yes 1p No
❑ Yes R No
WYes ❑ No
Cornments=(refei•-:to question #) _ Explain. anpYES answers4nd/or-_anyrecomme datiotis o`r. any other comments:-
Use drawings of facility to- better explain; situations (use additional': pages as necessary} w
T IF.nAA ire 6t� f xaa coo, . m %kovi�ry b,
16• `nSeG� �o�or
CvriTr'o� G�ae,l� 13� shoJ}c� be.
t`r ��rm-
VY-C�s.
lq . A [,k "e-S
©K \ yy- TA1i oy (y \04
CLS
4t,.,- r_CP-0 arc S t — wuh
Reviewer/Inspector Name _
Reviewer/Inspector Signature: �� s Date: 1,?16`g?
3/23/99

Facility Number: i — �� 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
EU Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
1 No
28.
Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt,
❑ Yes
MNo
Lr
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
[INo
/I
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
�1No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
RNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
WYes
❑ No
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
®Division of Water Quality
[P Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 31 0
Time of Inspection 0- 24 hr. (hh:mm)
© Registered 0Certified 0 Applied for Permit Permitted © Not Operational Date Last Operated:
Farm Name :........... �.Y.�7� %...-- T.h1V.MV,........6�ji Yam...... ....................... County:........ ......................................................
OwnerName:..........................C61 '.�%.-- ..... . ...................................... Phone No:..�a.ii}�.. �,�.:.` �1.�............................................
Facility Contact:
Title:. ..........................
Mailing Address: 111........ c4a.rs..... .tv1, «
Onsite Representative: ............ a 1,Q%.........NM .ir1-Qn,.....................
Certified Operator;....- .-.-.r-....E.., A�+C~r•sor.
................................. ...........................
Location of Farm:
Phone No:
..... hej.6_V-ALr-----1.110F................................... ..zw. s..........
F
Integrator:........... a.l!?'i11. 5........................................
Operator Certification Number,--.« j.Yj
..........L)n ..... 'aic ...a......... ( ..{ Zi ' ..,... I ... 5?.:. ... ► -1 5.......eas.E.-o
-- .................. ..................... .. ....------.--- . ...-- ... .
Latitude Longitude
Design Current _Destq. Current Design p: Current
Srvme Capacity Fopiilatioa Poultry Capacity i'opulatton Cattle Capacity Populattow
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Z C)[, ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
k'' ❑Farrow to Feeder` ❑ Other
ry El Farrow to Finish Total Design Capacity . y or,�
'• ❑ Gilts
❑Boars `` TotaIESSLW �-7 acx�
s
Number of Lagoons /Holding Ponds :� ❑ Subsurface Drains Present ❑ L ID Spray Field Area
goon a Area
UMf _ :.- y� �n ❑ No Liquid Waste Management System ,
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
2. Is any discharge observed from any part of the operation?
❑ Yes
(RNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
MNo
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
❑ Yes
(] No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
1A No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
0I Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
1A No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
A No
7/25/97

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LasmonsMoldine Ponds. Flush Pits, etc.
❑ Yes P1 No
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 10 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):...............12.....................I..................... .....................
10. is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 09 No
12.
Do any of the structures need maintenance/improvement?
[P Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
1)_4 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering watte`rs of the State, notify DWQ)
15.
Crop type ............... 'i1'.OW&...............alb 1d l ..... f.i.d1...... .......... .......... .................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
0 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
§4 No
18.
Does the receiving crop need improvement?
10 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
0 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
R9 No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or PerjWlt.ed Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
'N No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
Yes
❑ No
[]-No.violations'o' deficieneies.werenoteddoring this.visit.-Yoiu.will-recei've.noffwrther
:.•correspQndei�ceatioul;this:visif.-::�.: _�: .:-.:-.�:-.�:-:�::: ;�:::�
L2. gc+-ht W'to,% at-, d-k4 OJT 04 I r, S�n L) HOC, liWc5p- . 601> ,O , &V&S 0),4, Ouk—
d,1lA kb,�l 4� noo, 5�r� A �e_ fit rtsee�e
4• Ljet�% 4 4r- (eO f5. ,�ttiJ
ci wv�
{{ S Y bI n yAt 1 S�-V I r� � cx i`IA.e'J ei {zJ
GI -. �� Cal � ('a^ �aFt � �
�`�1 �
7/25/97 _

i�
.; ►►
ZzUfa E
j' 0 Division of Soil and Water Conservation ❑ tether Agency
Division of Water Quality - �•
Routine O Com laint O Follow-u of l)AV ins ectiou O Follow-up of DSWC review O Other
Date of Inspection �O
Facility Number 6�
Time of Inspection 24 hr. (hh:mm)
13 Registered 0 Certified © Applied for Permit 0 Permitted [3 Not O erational Date Last Operated:._..._.
Farm Name: AiMG ........ County: ..... 1).0 lia........................ ..............
Owner Name: ....C►xS,...... !n.An..................................... ............. Phone\o: C1Q�.YB.-..�,�5�.................... .................... .........................
Facility Contact: ... r.. .....�i P&0x%..................... Title:........ AWjAt......................... ....... Phone No: , �Slf��.?Aair-. su $�.......
+�(�i.:... N...... Mailing Address: �!a�.�...... 9rr• M►�.1......�.................................................................. �. � ..................................... ..2.$51�........
1j r
Onsite Representative:...L"&S................................................. Integrator:................................................................
Certified Operator ;........ G 10�C�t i........ c o! ................................................. Operator Certification Number;....... .��...................................... ............
Location of Farm:
Yc�..1.......... .... ..... .. .....nS1>t:. ........... rr....... ia�{.:...`Cc�!7.........eff..... n......Sf?�... �.-....urr...Y'.. f?�-........
..
.....fi- lit-Z..... on ..... `� .5?".....`�}....�..... A.. I^:1
Latitude • ` « Longitude • �� �"
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes [ CNo
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 11 No
❑ Yes 0 No
❑ Yes ® No
❑ Yes 153 No
❑ Yes A No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®'No
❑ Yes .0 No
Continued on back

Facility Number: r — t6S
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holding Ponds, Flush Pits, etc.?
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes ® No
❑ Yes IN No
Structure 5 Structure 6
Identifier:
Freeboard (ft): ..........2:..............
... . ..........................................................................................................
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/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste application
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering.waters of the State, notify DWQ)
15. Crop type i(,eAUIOI.r...............................................................................................SIkAl.....IY&i.n,.................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes allo
❑ Yes 5No
56 Yes ❑ No
❑ Yes [21No
❑ Yes RNo
.....................................
❑ Yes W No
❑ Yes ® No
TTo:viol ations:or. deficiencies. we're. noted-daritig this:visit.; .You.'will: receive-ito-ftirthei~
;•:�correspQndenceab"out this:visit:•:-:::�:�:•:• •:-::�::-:" •:-:�:�:-::::•.:-. .�:-.:.•
U Yes ❑ No
❑ Yes f ig No
❑ Yes ER No
❑ Yes fR No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
,Z, G"stA+n a.nos Ov% :Y-V%W d.'rw .watt skvv1J foe 41W w*Gttl c.J t-rire�ed, &,t- arrat sW
� fcseP.c�eci- ©� b:4t,�. w,a11 skovlci bc.. t�ow�•
�S- 8�,-n►��� crro1 i� �',11t.iJ �� s►.a1J 1n�11 : tw.�-avu� l i�t�' ��'.
tL. (.ec5nar� 6) esu S�lov�tl doe ;h CZYti�td Q4Lun. {��OgrC Sel c5}
7/25/97
ReAewer/Inspector Name
Reviewer/Inspector Signature: .j` A"— A- A )ADate: !Q

j Site Requires Immediate Attention: X
Facility No. aI - L2Qa-
DIVISION OF ENVIRONMENTAL MANAGE7.1ENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
A! DATE: 1996
r. Time. U c3
Farm Name/Owner:T 67-
Mailing Address:
County: �D 40p j IAj -- _
Inte--rator: % A ,2 20 (i 4 Phone:
On Site Representative: L-JAJl e, l C<, Phone: Z Q - rj Z 7- k
Physical Address/Location:.- 1-7 Z t-( ZIP Rro x. �_ �
Type of Operation: Swine Poultry Carrie
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEI� Ce: afic on Number: ACNEW
Latitude: J? d Longitude:Elevation: Feet
Circle Yes or No
Does.the Animal Waste Lagoon have sufficient freeboard of 1 Foot _ 25 year 24 hour storm event
(approximately 1 Foot _ 7 inches es r No Actual Freeboard: _ Ft. U Inches
Was any seepage observed from the lagoon(s)? Yes otQ Was anv erosion observed?(! " r No
Is adequate land available for sprav?6;� or No Is e cover crop adequate? (n or No
Crop(s) being utilized: ' a]
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e or No
100 Feet iron Wells?ne or No
GIs the animal waste stockpiled within 100 Feet of USGS Blue Line Sseam? Yes or.19
Is animal waste land applied or spray irigated within 25 Feet of a USGS lvtap Blue Line? Yes ort
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?0�0 or No
Additional Comments: IYV l S -
Inspector Nam Signature
cc: F:icilicv AsSessmenE Unit Us,- AttachmenEs if Needed.
'CCU S ueXAGC- V4 tit, ATrhl�S
c A..raec_ A-A-jO--1-97,FD iAc k,�Wti7 2rPA e_ A5►9P>

Site Requires Immediate Attention: IX
Facility No. 3 1- igs
DIVISION OF ENVIRONMENTAL MANAGEMENT - Avo S1- U 1 Z
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3 19995
Time: O0
Faun Name/Owner:�i _{�L 5 D� ( _ ��g.e I 7 K, n050A
Mailing Address: -71SJd C_o2A • A 1(_ ao-,ce P-):-J tauL i (e z V( Sl 8
County: _1
Interw-ator: (Zb �� �- _ Phone:
On Site Representative: JA) Phone:
Physical Address/Location: 1 Z `- � PQrz� x . ma's aol7
Type of Operation: Swine Poultry Cattle
Design Capacity: 19GO .54L)_ Number of Animals on Site: i 9W -
DEM Certification Number. ACE
DEM Certification Number: ACNEW
Latitude: Longitude: " - Elevation: Fee:
-.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�r..No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes otQ Was anv erosion observed? (f! 'r No
Is adequate land available for spray? or No Is toe cover crop adequate? (a or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings?n or No
+ 100 Feet from Wells? e)or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oreg
Is animal waste land applied or spray irigated within 25 Feet of a USGS Map Blue Line? Yes ot�
Is animal waste discharged into waters of the state by man -trade ditch, flushing system, or other
similar man-made devices? Yes or CID If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cove: crop)? re or No
Additional Comments: _IMP— Ajr,.ys Yvv l S .;IDQ r'1G�FSS c7 V -
�` 6asE, LAil�S�t- (caws Ake To r- L c7uJ7�UAeL.
-
`� Inspector Nam Signature
cc: Facility Assessment Unit t<sl- Aaacliments if Needed.

f.
• r
0-
11
Site Requires immediate Attenlon
Facility No. �5
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO SITE VISITATION RECORD 7
DATE: , 1995
Time:
/1 A
Farm Name/Owner:
Mailing Address:
County:
Integrator.
On Site Representative:
Physical Address/]
®�#1
P-01
G Phone:
Phone: g
Type of Operation: Swine Poultry Cattle
Design Capacity: �r& ZO ; Deftj�Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: • ACNEW
Latitude: ' ' " Longitude: " ' " Elevation: Feet
/Jo CAS AllV e 4g16 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) Ye or N Actual Freeboard: Ft_ A Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Ye r No
Is adequate land available for spray? Yes or No Is the cover crop adequ e? Yes or No
Crop(s) being utilized: �� ��� to i%��-
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellinqKyeN No
100 Feet from Wells' -Yes k No
Is the animal waste stockpiled within 100 Feet of USGS Blue -Line Stream? �s 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 a state by man-made ditch, flushing system, or other
similar man-made devices? Yes C i If Yes, Please Explain.
Does the facility maintain adequate waste management records volumes of manure, land applied,
spray irrigated on specific creage with cover crop)? Ye or No
Additional Comments: m��✓I� ��
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.

J UL_
i
s
Site Requires Immediate Attention
Facility Number.
!` 5IM VISITATION RECORD
DATE: S -q rt .1995
•
owuer. - Air- Farm Name:
County: Z)O PL 1,4 —
Ag5nt Visiting Sits: h Phone:
Q10 2q6 -:.1 z0
Ope tor: Phone: -Z9 8 -.Sz z a
On Sate Representative: Phone: q w - Zq.3 ? +
Physical Address:
Mailing Address: ' l
Type of Operation: Swine X Poultry Cattle
Design Capacity; _
Latitude: o
Number of Animals on Site:
" Longitude: o "
Type of Inspection: Ground — X Aerial ,,.,`
zCircle "Yes of No
Digs the Animal Waste Lag
oan have sufficknt freeboard of 1 Foot + 25 year 24 hoar storm event
z (approxim rely 1 Foot.- 7 inches) Yes or N Actual Freeboard:12 Feet _4?_- -inches
For facilities with more than one lagoon, please address the Other lagoons' freeboard under the
comments section.
kas any seepage observed from the I oon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
Fax to [phone]
Signature. of Ageat

OPERATIONS BRANCH - WQ Fax :[phone]S
Aug 1 '95 10:"29 P.07/13
5iue Rtquires Lra=diace
KIM ���IT DTI()- RECOPID
Cou=y: —._its nL r
.kr r152t]nG '!'�' a•r �n x`�OL�e: �"T if) "2f-3�1 t ZO
E:-
IJ.1�1JivC1 rhldldr4SS: (%V) �')�A..��.- _r G✓"/r" r -.J �_"`��'�__JY C.. ...�4►•� -.w
1�._.1ia- Address, - i nx' " 1254- 68
r
T;,;e of Gperc: Swine ,`< pouI�r �._ Cattle
1 CapLzi . Nu-mber of -�xrarLs on
I,ati�de: •� ° - _'-----" Lon4 sud�- ....._..._T...° ,.
Type of "Iris- ecdon- Ground
C xuic; Yes of No
D{s s r 'a fl e �.w n+ t �i f 5 r r t
� the .ina1 �, ws� I 3�,�. a� �a :� sib .. ... �'e� -.. r� a 3 �'nat -" ? } ear 24 ��r�r s � even
wz ) (approx.L=ely I Foot r 7 inches) Yes or � Actual Fzwbo,:d: P .. Fee.: , :�Inches
t 0 F-w facilities Frith more dr-n one lagoon., plaa�� -adds"-ss t1:e other iaecors' wide: Ltru
cc � -�
SL' C.oInI: 0-flLi yPCCi�d_ tatpaya cGser,,ed from the layw (s)? ye-5 Off' _'VO W r�,er; eIC51on of t? ; d?�: �" Y,'.s CA -Nr,J
Is adNuase laud available for land application? -Y cz or No Ts the cover cxor adtgvaral Ye's or .N,,)
Additional Co mx-nts: - �-- --- ---�-- �_..
F"ax t) r.919) 715-355� :%� �,.a.JrE:,FA 2, --4:

A79 r_D
Site Requires Immediate Attention: ti'S
Facility No.1
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANTMAL FEEDLOT OPERATIONS SITE ViSTTATION RECORD
DATE: 11995
Time. 1
•
Farm Name/Owner: t4TWso �j
Mailing Address: 1
Glag
1 i° 4
0, 18
County: lw 0 t.. I rJ
Integrator.
Phone: S 1 d R- S ��
On Site Representative: C 1+pc
�'"'�°'J
Phone:
Physical Address/Location:
(I I
rZ'_�
Type of Operation: ' Swine
✓
Poultry
Cattle
Design .Capacity: S+O
__
Number of Animals on Site: S + (3
DEM Certification Number:
ACE�.
DEM
Certification Number: 'ACNEW
Latitude: 4' 0 Longitude: -1 4 I o " 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) Vor No Actual Freeboard: -Z�_ Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or 1�0
Crop(s) being utilized: k K crf LASS
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Yes r No
100 Feet from Wells? es r 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 -trade devices? Yes � If Yes, Please Explain.
Dees the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes ffro)
Additional Comments: �' t1A ,rt.e S
'Dom --rc r (-tom-jC f�_STp_F3L
A' LL—
Q, L: t ► TZ'"L _ L'�� � _ I -Ab O P rt" A (LPA- -
i-j-5
, ft-t_ (Lo-" `-i P 1, f 6 ::
b M lei l V\, f ftM 5
, FeLkCQ,* rJT'
saJb(' , -4 L-40-&e,J.
!<ti065
ON T" )►-3 V
ULCQLAdN l'l G-h
� 2j
Inspector Name
-W__ _
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.