670057_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental QuA

0%
5
(Type of Visit: MICompliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: i Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access tj
Date of Visit: z Arrival Time: iQ Departure Time: '• County:
Farm Name: We T Owner Email:
Owner Name: �(k'l Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Al W I � t }
Certified Operator: &Lzv)
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Region: �v i E)
Certification Number: I � 3 tp
Certification Number:
Longitude:
Design
Current
Design
Current.
DesignCu�rrent
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capac ty . Pop pk
Dairy Cow
Wean to Finish
La er
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish
bOU
5(Q
Dairy Heifer
l'
Farrow to Wean
Design
Current
Dr Cow
Farrow to Feeder
1]r P,oultr,
Ca acit
P,o
Non -Dairy
r
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
i
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
NJ
Other
11
L_LOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
❑ NA
❑ NE
b, Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ 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
XNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faelli Number: - Date of Inspection: Z/ i2 f
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: 1 3
Spillway?:
Designed Freeboard (in): '
Observed Freeboard (in): 3 D r-t �
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�(No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
X No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Z 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 Ai mlication
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
XNo
❑ 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 Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
-Crop
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
19NO
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[X No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ Yes No
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 9 Yes ❑ No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes ❑ No
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 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 No
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued.

Fpr ility Rumber: -7771 Date of Inspection:
j
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
kNo
❑ 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
NNon-compliant sludge levels in any lagoon
date indicating 041/!
List structure(s) and of first survey non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
6 NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
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?
t-1 - I/ 6u-k 0 w rtA fy) 0 wUr
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11
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s.4y cJLf [Y 21)[1 Puryxflvl� 401V" PMi r�k- in 0- -
q6Ai - spud �, %ter 0, us- r( 2-1 f 111 (survey. %VI'A
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kYiS+111.ey"XaMZ; P hc)40r, ai)v
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4.%
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❑ Yes NfNo ❑ NA ❑ NE
❑ Yes R71JOJ ❑ NA ❑ NE
❑ Yes )kNo ❑NA ❑NE
❑ Yes jgj No ❑ NA ❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
alNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Reviewer/inspector Name: 6 S .t~ I y�� AA v--,
Reviewer/Inspector Signature:
Page 3 of 3
�rliyVi b.ak ['- 1"eC+'r�c,Idr " hp'i_'
re fvrn � wr.� -�a 4ta �
Doh,
Dwk W �VA Hfa r ''.s AaH ke4
Phone: V710 —7 3 V
Date: 121 I 2,111
2/4/2015

Type of Visit: (3 Co
Hance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: � County: j)k Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Au kjJ f f—M Integrator:
Certified Operator:
Phone:
Certification Number
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
11. �'3
Design Current
Swine Capacity Pop.
Wean to Finish
RNon-Layer
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Popp.
Layer Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Dairy Heifer
Design Current Dry Cow
P. Non -Dairy
La ers Beef Stocker
Non -La ers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Turkey Poults
Other
Farrow to Feeder
Farrow to Finish
Gilts
Boars
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 ZfNo ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
[] Yes ❑
❑ Yes
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

acilit Number: jDate 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? O Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I 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 environment I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes fNo ❑ 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 WN ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 Eo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes <
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rN
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes;/N
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 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 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

❑ Yes Ej"'No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes EZ No ❑ NA ❑ NE
❑ Yes [3/No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
]Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑NA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes M VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signatui
5N0
K
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
G 3
21412 J,5

Type of Visit: Q4Compliance Inspection U Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: Odoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:O�SC�..% Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: / Integrator:
Certified Operator: Certification Number -
Back -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean Design Current
Farrow to Feeder t iPo
Farrow to Finish Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
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 21 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
[:]Yes ;2"No
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facili Number: - Date —of Inspection: %
Waste Collection & Treatment
4. Is storage capacity (structural. plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure
�� 1tt Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Llq 6yJ 1 to 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme al threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o [] NA [] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 [3Yes 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 > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[3Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[3Yes
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
Ej"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
dYes
❑ o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
[eNo
❑ NA
❑ NE
the appropriate box.
❑ WUP [I Checklists (—]Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. U 1 cs ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ErTNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FdNo
❑ NA ❑ NE
Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: T: � - Tz 4 1 jDate of Inspection: 4 fit-// 1 j 1
24. Did the facility fait to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes �rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [/�No ❑ NA ❑ NE
[:]Yes [2No ❑ NA ❑ NE
[:]Yes q �N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes I_J<NN ❑ NA
❑ Yes gNo
NA
Yes ❑ NA
❑ NE
❑ NE
❑ NE
(Comments (refer to. question #): Explain any YES, answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations{use additional pales as necessary).
tP� h/A�s Co
sWvE y �
Reviewer/inspector Name:
M R(60r
.� '0Avf -,Ax lb 0w P
W
r
Reviewer/Inspector Signature:
Page 3 of 3
Date: fey A
2/4 014

(Type of Visit: (3 CCopliance Inspection O Operation Review Q Structure Evaluation p Technical Assistance / I
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: ai ),XA Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: o Integrator:
Certification Number: 1L0' 3 zc
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
can to Finish
Design Current Design Current
Wet Paultx3 C*apacity Pop. Cattle Capacity Pop.
Layer _.iry Cow
can to Feeder
1
INon-Layer I
iTy Calf
Feeder to Finish
Farrow to Wean
Design Current
it C•_a aci P,a
airy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
I Layers
Non -La ers
Pullets
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turke s
Turkey Pouets
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes aeo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No [3 NA ❑ NE
❑ Yes �70
[3 NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: rwl - Date of Inspection:
it V-7
Waste Collection & Treatment
4. f storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
D Yes
EZ 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: LAGooO LAG1noJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
/No
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑YesgNo
N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZN ❑ 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 E ❑ 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
[Z N ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesV
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesgNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: Ile
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes YNo ❑ 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 rJ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E 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 structurc(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ 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 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes P/No ❑ NA ❑ NE
❑ Yes [�No
❑ Yes 'Z� a
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name: N ���, L.VA Phon q 0) 9 7 3
Reviewer/Inspector Signature: Date: a-1.2- 7 /1
Page 3 of 3 21412011

(Type of Visit: (0 Compliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit:y,(Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: g U Departure Time: %00 County: 6AJ9L6k) Region:
Farm Name;
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ALJ.� IR4R' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1 � 13
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Dur esign Crent
Agfl Poultry C*apacity Pop.
Layer
Design Current
Cattle C►apacity Pop.
Dairy Cow
Wean to Feeder
INon-Layer I
Dairy Calf
j(
Feeder to Finish
1600 OT7
Dairy Heifer
Farrow to Wean
Design6011IMent
D Cow
Farrow to Feeder
on
Dt� P,ouitt. Ga aci P,a
Non -Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
I 1
0 1
Discharies and Stream Impacts
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 2f No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [] ❑ NA ❑ NE
❑ YesVNo
❑ NA ❑ NE
[3 Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

s?
Faci i Number: - Date of Inspection: ti 3
'f Waste Collection & Treatment
i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA &W61 LA(,dojg LAG -off 1`r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2� Z LID
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [� No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes jNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment l threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes [%o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [% No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes M o
❑ NA
❑ NE
❑ Yes Zo
❑ NA
❑ NE
❑ Yes WNo
❑ NA
❑ NE
❑ Yes o
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes C� o
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
[:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

5?
Facility Number: 113ate 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 ENo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes [j No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ENo ❑ 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
2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
�No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CZ/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�J_o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[3 Yes
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.: ,
Use drawings of facility to better explain, situations (iise additional pages as -necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
6
Phone:( 3g8
Date: t
/4 011

Type of Visit: Q Co
'poliance Inspection () Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Z Arrival Time:�--� QDeparture Time: / County: ,�� '�'� ��'� V'r Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Au of T&�q Integrator:
Certified Operator: Certification Number: b
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
esign Current
Cattle pacity Pop.
H
Wean to Finish
La er
DairyCow
Wean to Feeder
Nan -La er
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Feeder to Finish fled
Farrow to Wean
Farrow to Feeder
Design Current
Dr; P,ouitr, Ca aci P,o
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
F15ther
Turke s
Turke Po ilts
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? (1f 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 ❑ / ❑ NA [] NE
❑ Yes ❑ NA ❑ NE
❑ Yes o ❑ NA [] NE
Page I of 21412011 Continued

Fadlity Number: jDate of Inspection:
Waste Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 2�No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4
Identifier: 1A6m2j - Wtpy3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1-
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:3 Yes 2/No [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [3 Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑
7. Do any of the structures need maintenance or improvement? 0
Yes o
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
❑Yes fNo
❑ 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 �10
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes allo
❑ NA
❑ NE
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
a
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
II o
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
640
❑ NA
❑ NE
Required Records & Documents
N
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
0
❑ NA
❑ NE
the appropriate box.
[ )WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Othe .
21. Does record keeping need improvement? If yes, check he appropriate box below. Yes ❑ No ❑ NA [3 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes g �No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDateof Inspection: L
` 24. Did the facility fail to caliklrate waste application equipment as required by the permit? ❑Yes MN .[:]NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesVNo❑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 2fNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes:�No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes G3<a
❑ Yes &KIC
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments(refer; to question ##): Explain any YES answers, and/or: any additional recommendations or'any other comments �5
Use dr.'iwings:of facility;to better'explain situations (use.additional pages. as necessa ) m Qp_, �u,
�f� 20tI MAST, APAUeSi5 PASIVdT RCCZ60jJ q. CALL AtW)4C� );a- It-U67-klr
irrru 2- wE E kS,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date: 3 /9 h t--,
21412011

Type of Visit: (2rc liance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up 0 Referral O Emergency O Other Q Denied Access
�I Y�YII I IIYYYII
Date of Visit: (o J jIi Arrival Time: ® Departure Time: County: Q&gL& Lj Region:
Farm Name: �f Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ALL(- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine
Capacity
Pop..
Wet PoultrYy
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
DairyCow
Wean to Feeder
]Non -Layer
DairyCalf
>(
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, P■oult�F
Ca .aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
©.ther
TurkeyPoints
Other
I
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 2/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes rNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - s Date of Inspection: t
kVaste Collection & Treatment
. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
Wi 600vl 1 LA G-o J
Structure 3 Structure 4
CAG ctliJ
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
❑ Yes ][�No ❑ NA ❑ NE
[:]Yes [3/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 6o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FZ/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 [2f No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FI'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesEk<'o
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a/No
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�-3/
[110
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F2/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
YNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Fucili Number: - Date of inspection:
2. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes z❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes WNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [,21/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes dNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes E. No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes ,/ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E(No ❑ NA ❑ NE
Reviewer/Inspector Name: OHO RL t_ Phone:
Reviewer/Inspector Signature: Date: 3
Page 3 of 3 21412011

I
jLFac11i , Number 16 ,
Type of Visit 0 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: T
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: Q t]d Departure Time: County: 04Q.00 Region:
Owner Email:
Facility Contact: Title:
/�
Onsite Representative: ►" L -Mo-q
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= 0 0 d Longitude:
Design
Current
Design Current
Swine
Capcit
Pouatin
Wet Poutry
Capacity Population
attle
7E9=1
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
on -Layer
❑ DairyCalf
Feeder to Finish
'7(ZO
ZZf
❑ Dairy heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
El Turkeys
Other
❑Turkey Poults
❑ Other
❑ Other
Number of 5truetures:
Discharges & Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NN
❑ NA
[I NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Yw
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:� — .S Date of Inspection ! D
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: Arm,,) ) LA6-w .3 LAis,00J q
Spillway?:
Designed Freeboard (in): Observed Freeboard (in): ` 13 �i L 44 Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 yes �No El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes l_dNo ❑ NA ❑ NE
mai ntenanceli mprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[:2<o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E;KNo ❑ NA
❑ NE
N
17. Does the facility lack adequate acreage for land application?
❑ Yes
El NA
El NE
18. is there a lack of properly operating waste application equipment?
El Yes
VNo ❑ NA
❑ NE
Comments (refer to question #): Explain any YES, answers and/or any recommendations or any othe comments
.Use drawings of facility to`better explain situations. �(useadditional pag",.as necessary):,
2,o G-C C v PA-e6kq 13 vu G, AG _ ,
•
2S :) kE F p CoeY ef SZu n G f L,,T04 kC-0itflS,
Reviewer/Inspector Name ;V`' �, , ¢ Phone: 70) 7 o( �— 7379
Reviewer/Inspector Signature: Date: S
Page 2 of 3 12128104 Continued

i -
Facility Number: &7 — Date of Inspection D
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 components of the CAWMP readily available? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box. WUp [I Checklists ❑ Design ElMaps
El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Cl Yes
,�
U No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
d',
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
�(No
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
�y7e
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes�Zo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M 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?
/o
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�;No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2 No
❑ NA
Cl NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[ to
❑ NA
❑ NE
12128104

,c
Type of Visit C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: 7s' Departure Time: County: aNSL401%1 Region:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: 40 d UAG J ffin "
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o = ' = Longitude:
1 1 �
Design Current
Design
Current.
Design Current
011
Swine M11111
pacity Population
aIt
Wet Youltr�y Capacity
Population
Cattle Cap city Fopulation
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Caif
© Feeder to Finish
`7
o
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
ElNon-La ers❑
❑Beef Feeder
FE113oars
Pullets
❑ Beef Brood Cow
I—FE-10ther
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NN
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
L'J N
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

'r Facility Number: ` j —
Date of Inspection
W' aste 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: L frWN n/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 Lib
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ((No
❑ Yes ❑ No
Structure 5
❑NA [I NE
❑ NA ❑ NE
Structure 6
❑ Yes
ZI o
ElNA
❑ NE
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaleat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes YNo NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑ ❑
9. Does any part of the waste management system other than the waste structures require El Yes 0 No ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D No ❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
UrNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
��No
❑ NA
❑ NE
,ZS� CA (rod&)
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
DaNF AsW N6W Fcgo,�rTs 5.-oAl
E Phone:
�... i� Date:
-73A�
(67
Continued
12178104

Facility Number: b — Date of Inspection
Required Records & Documents ,,,,__
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes E34 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EKNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ g Other
p
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
❑ 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
ENo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
6"No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
VfYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
eNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,�
rJ 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
U 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
E N
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
H
Page 3 of 3 12128104

I
Type of Visit 0TRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 (01 I Q0 9 Arrival Time: ® Departure Time: County: ArNA _ LJ _ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Wit-.4 AL I Roll
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =]' =' = Longitude: = ° =' 0
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C►apacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer I I
Cow
❑ Wean to Feeder
❑ Non -Layer I I
-airy
airy Calf
® Feeder to Finish
r OM
O 3 U
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Layers
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
ElNon-Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Turkeys
❑ Beef Brood Cow
Otj
❑ Other
10 Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
El NE
❑ Yes
❑ Yes
No ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page i of 3 12128104 Continued

Date of Inspection
Facility Number: (ot =
Waste aste 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: (A(,,a61J I LAGon'J 3 (ACr�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
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
ENo
❑ 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
eat,
environmentaZo
notify DWQ
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?
❑Yes
L�J No
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
WNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
'o
❑ Yes
[I NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes ZNj
El NA
[I 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 DZ
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes LJ
❑ NA
❑ NE
20) ,,i Ec•a W up i 5 Sa �RocST dF (3C iW G _>01,16 .
at) u P �aIC S-rdycz-(-� C - Reco o FOP- .
ReviewerlInspector Name orb` G. �v^;` :��:r'1 Phone: ��lb)i�iG _�3�Sd
Reviewer/Inspector Signature: Date: $
i u5c vJ . ..,. .. ...........

Facility Number: — Date of Inspection {0 a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Y s LJ No El NA ❑ NE
20. Does the facility fail to have 1 components of the CAWMP readily available? If yes, check L7 Yes ❑ No ❑ NA ❑ NE
the appropirate box. 0 WUp 0 Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. n Yes ❑ No ❑ NA ❑ NE
❑ Waste Applica ' n El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
El Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain InspectionVt9
Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes o❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WNo
o ❑ NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit`? El Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes !J No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes E3 No ❑ NA ❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
WNN
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
ON
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2fNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0"No
❑ NA
❑ NE
Additional,Comments andlpr Drawings
zf 1 YY i f
Page 3 of 3 12128104

f Qj Division of Water Quality
Facility Number 1 S ? 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit ("Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit g Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Yao Departure Time: County: JNSLoa Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone:
Title: Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 Q Longitude: = ° 0 ` =
41
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
on-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
[:IT urke s
❑ Turkc Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy -Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
12128104 Continued

Facility Numher: (.� — 5? Date of Inspection a�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ef 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: LAt'm'J,3 t-AG�a�i_,�
Spillway?:
Designed Freeboard (in): 'lit 'La >�
Observed Freeboard (in): }l S L 3 Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EfNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Z No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
12 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E 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
Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El2 Yes
/
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L'J No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
allo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C2'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ 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):
ao) typpq-fE WUP SO Tknrr F,1ELO5 ARE 009'� Gy PYMAO'r PUW , $EeCeLATC Aci.Ea6E oOT
`
Reviewer/Inspector Name a is q�j Phone: ( ^tto 19G 3V
Reviewer/Inspector Signature: ems- Date: 3 f7 G e
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have components of the CAWMP readily available? If yes, check 13 yEl ❑ No NA NE
the appropirate box. [gyp []Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q/No , ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
L!f No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ 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
ZfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2�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?
El Yes
�/
Ld No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[�(No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,(
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L�J No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ZrNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

�
a Dtv�sion .0
f Water Quality
Facility Number� Division of Soil and Water Conservation
Q Othcr`Agency
Type of Visit Coo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S Z5 Arrival Time: 3 V Departure Time: County: ONS U �J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: gilt. 4- AL r or P_ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e 0 I ❑ `i Longitude: = ° = i ❑ «
Design Cur
Swine Capacity Popul
❑ Wean to Finish
i
❑ Wean to Feeder
® Feeder to Finish
OW
6i
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars _. ..
_ J
❑
Layers
ElNon-La
ers
❑
Pullets
❑
Turke s
El
Other
❑ Other �:
Turk
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design'Y Current
Cattle.C."
apacity Population;,:;'.
El Dairy Cow
ElDai Calf
El Dairy Heifer
El Da Cow
❑ Non -Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Cow
Number of Str
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
ElYes 4No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
El NE
❑ Yes
❑ Yes
No ❑ NA
❑ NE
❑ Yes ao ❑ NA ❑ NE
12128104 Continued

Facility Number: — i Date of Inspection I s►a
Waste Collection & Treatment
4. -IIs 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: ALOW I CAWrJ 3 C.14-frwd 0
Spillway?:
Designed Freeboard (in): U �i0 ti0
Observed Freeboard (in): 7-5 s
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 E;YNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes VfNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immedinte,public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes o ❑ NA ElNE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ YesjNo
El NA [I 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 ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes iNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 13 (,&) F LCO) S &0
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
Cn No ❑ NA ❑ NE
L'1No ❑ NA ❑ NE
ET"No ❑ NA ❑ NE
0<o ❑ NA ❑ NE
U�o [I NA ONE
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):
r3DNC OftXCATLOA CAV(ZN(, L"s T910 10% IWCA-Apt, 6CUM.C.0 oN 560 pLCASG 6C
`
CARCFv1. ,Vj 5 tlhL� .
nLZ iZCQU[+cro av-.7LOS Ir"P.,. A4_'/-LdVj livsPbcm ✓ 003E
k& SS ' 1ZkATXjJG &OfrJ I rpn. (qND LA000- 1 3
Reviewer/Inspector Name F —�'Q�� YA�JI�FJ+I. 1 Phone: Q1b�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number; — S Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21.
DL' record keeping need improvement? If es check the appropriate box below,
Yes
❑No
❑NA
NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
PP Y Y
El Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ENo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,�No
tU/ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
GR o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
DAo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑Ao
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LVo
❑ 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
9 o
❑ 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
940,
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes;N0/
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 7Routine
pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit O Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ! 13b 1 Departure Time: County:. Qydlh'�J_ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: AU15AI _ fgdV-__ _ Integrator:
Certified Operator:
Phone No:
Operator Certification Number:
Back-up Operator: I Sack -up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other --
Latitude: ❑ a = { Longitude: [= o = t = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
II ❑ Non_ La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [/No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
❑ NE
❑ Yes
ElYes
El NA
❑ NE
El Yes
VN❑ NA
❑ NE
12128104 Continued

Facility Number: 67 — ] Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LAG 00AJ bA 40�1(3_ %a G-Oan1
Spillway?:
Designed Freeboard (in): 1/0
Observed Freeboard (in):�t.-% Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 3 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes K 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 E?fio ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E>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;4o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E�NO ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [,lo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% or I01bs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) I3&I'my04 "-) S%O
13. Soil type(s) Li AJ (4 Gu 2% 6oL.o s Bali A +c3at21= r�1 A t%TR-�►/sLLE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E?N' o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
D o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination':
❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,L_JNo
LS ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
�4,) iaEP UPY di ANuUINL CERT. S"o" Stjag6l1' A)jj) CAt.ZejLA-t_rd,J kIZV4
RC co 0,1D5, K6 CP TAt�k, N .=rJ TEG(Lt 16r'-- FeW, VA)OA
AVC-P-A & E
Reviewerla�
—z--
�
ui.+O?" %Inspector Name .
ReviewerlInspector Signature: Date: (,111057
12128104 Continued

Facility Number: — Date of Inspection 5
6� s� Lt�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes lyd`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 appropirate box. ❑ WOP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis Waste Transfers LAnnual Certification
❑ Rainfall DOStocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Is No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E2,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[5"No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�
GC 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
o
❑ 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
_,�
11 No
❑ [CIA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Rio
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NI
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Cortefiance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 4 Time:
Z. Q Not Operational Q Below Threshold
Permitted dCerffied 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
FarmName: ...... OdU..... I ........ ......................................... County: ............. Qis......................... .......................
Owner Name:
Phone No:
MailingAddress:.......................................................................................................................................................................................................... ..........................
FacilityContact: .................1.......................................I....................... Title:................................................................ Phone No:...................................................
Onsite Representative:..wF ... ....NA.L ..... !�...................................... Integrator: ......... ?M +............................................
Certified Operator: ................................................... .. . ...................... . ................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle 0 Horse Latitude 0 4 " Longitude • d «
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 gai/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 2 0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes[lNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes io
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... I.................. ..............3.............................................................................................................................................................
Freeboard (inches): 0�' 4
12112103 Continued

F acility Number: — �] Date of Inspection h b
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures Iack 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? If yes, check the appropriate box below.
❑ Excessive Ponding� ❑ y1 PAN ❑// Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type I.�KUM LG+ 1 FOCO(-,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
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.
❑ Yes [ JNNo
❑ Yes 2/No
&Yes ❑
❑ Yes N
❑ Yes Q
❑ Yes I
❑ Yes o
❑ Yes Y
❑Yes U6
❑ Yes Z o
[IYes J No
[(Yes ❑ N
❑ Yes No
❑ Yes d No
❑ Yes
❑ Yes ONo
❑ Yes �No
❑ Field Copy ❑ Final Notes
?)
�s.Y & Lo lt4W
QrS4it9 944 'PZW_ Go r O & .:Wb
L46-40 0 3.
�$,)
L .i impuG
LJ6Efl G6W1Ld -: fo
Gt, os.
CIQG ?i WYiS
-rS506D C<—AY2AL
496A? 1.1`r TO
ZeiD3 ;t>uT 3a 1-0"
01'f WAS
.G�
GN�ruGIGO 'Qv
7606 0ECDW-
7a f'IM-rSN , fj?015
"C'OLD oom (?&CA
rrsu ,
,jw5t6 ANflLtSS AtJD RCST OF 9"-a DS ZZ1.1 G-%"cD S PAP( ,
5-1-0 Aauvr � AWCT� AW"rrAT.r� gY F'.=�LD t'za APFL&AT1246y FULL
ptswss ws t,�Qroes+� 5� !� AS t�,s srat t�s�� aF
DEs �GU 4t ptpE �i.oWs� Z�.yro c..A vowJ 3 1'0
Gcp �6, �Ns r pee_ i.E VE L GA U4,6 '50 'TART e rXE ,r J LEVEL MAC W DicATE
Reviewer/Impector Name fix;
Reviewer/Inspector Signature:
Date: 411,1103
Continued
A.61Abl VJ

,Facility Number: Date of Inspection
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?
NPI)ES 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 lNo
❑ Yes
❑ Yes X0
❑ Yes a No
❑ Yes ❑'NO
❑ Yes ❑ No
❑ Yes 1�4
❑ Yes I NV
ElYes No
As No
❑ 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
❑ I20 Minute Inspections ❑ Annual Certification Form
12112103

dff . r. I.
Type of Visit 10 C mpliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility NumberEZM--[=
Date of Visit: Time:
EEM
Not O eratiopal Below Threshold
13 Permitted 0 C tified 10 Conditior�lly C rtifiied 0 Registered Date Last Operate or Above Threshold:
Farm Name: J 1' County: y�40�
Owner Name: Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
Title:
No:
'— Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle
❑ Horse Latitude
Longitude
Design
Current
Design
Current
I I I I III II III II I IIII�II�Y�1�1�
Design Current
Swine ..Uapacity ..CapacityPopulation
Wean to Feeder
Feeder to Finish OD
❑ Farrow to Wean I I I
❑ Farrow to Finish
❑ Gilts
Poultry tavacitv Po ulation Cattle
❑ Layer I I ai
❑ Non -.Layer. ❑Non-Dair
❑ Other
Total Design Capacity
Total SSLW
❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Number of Lagoons
HoldmQ Ponds /.Solid Tiaps I I ❑ No Liquid Waste Manaeement System
Dilgharge5 & tr am 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 pan 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
S,truct re I Stpcture 2 Structure 3 Structure 4 Structure 5
Identifier: #
Freeboard (inches): �7_%
❑ Yes JVNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �No
El Yes �No
ElYesXNo
Structure
05103101
Continued

Facility Number: — Date of Inspection
5. Are 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
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ YeZ/�
o
11. Is there evidene of over application? ❑ E essive Ponding ❑ PAN ❑ Hy ulic Overl
❑jYYeo12.
Crop type
L
13. Do the receiving crops differ with those designated in the Certified imal Waste Management Plan AWMP)?
Yes
No
14. a) Does the facility lack adequate acreage for land application?
El 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
1.5. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
El Yes
dNo
Reguir-d_Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[INo
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
gNo
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
[I 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
XNO
22. fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
/No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNO
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Caminents (refer to'question #) Explain�ey YE5 answers andlor.any, recommendations or anyother comments ,
a�.. E s = t
drawingsoffncility, situations; its
Use to better explain (use additional pages necEssary) . .' Field Copy ❑ Final Notes
u,.
s _ -
/ 2*9,t 7or
��(i 4{./ �/• �/�,��f� !/O�/74 ��I' � r � �% �/' +� ✓�f.//I Kam!'
o
H,
Lay
Reviewer/]nspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

a ')*
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?
Additional Comments and/or Drawings:
❑ Yes ❑ No
❑ Yes o
❑ Yes No
ElYes dNo
El Yes o
❑ Yes No
❑ Yes ❑ No
lq)-be � -� -1 -7
-5ege- ;�P AF45z4ez'-Af -0�' Al�e'56
�,¢5pF /�✓f}GySzS �r000 A-O� �PP) z*/S �a-e,e 7
��j�G�C'�TZoi✓S 1� ��y h`NO
xv
n �,'�: D�/��G � �zTF is Z �o �or✓dz7�,
���OPOS ORG-ANa.zEo ��o �om9�.�7�
ate` ZZ�.
05103101

I 41
-w.f WSoa. ter! Quality.
0Dilkand Water Conservation IvIslon o
11
�. Qthei Agency, .:.
I' ,�1�33
„ {
Type of Visit
Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit
*Routine O Complaint O Follow up O Emergency Notification
O Other
❑ Denied Access
Date of Visit: Time: EFFG—c-D Printed on: 10/26/2000
Facility Number
Q Not O erational O Below Threshold
Permitted [3Certified 0 Conditionally Certified [3Registered Date Last Operated or Above Threshold
`� .'................................................................................................. County; ....
Farm Name: ........:1.� -1.'. n�"�
OwnerName: ................................................................................................... Phone No:...............:.......................................................................
FacilityContact: ............Title:.............................................................. .. Phone No:...................................................
Mailing Address: ................................... ...........�........... �.....D!�q.�:.:�!.....
f �.............................................................................. ['................. ..........................
Onsite Representative: ^!l'..............................................:.......................... Into ratord'.............................................
Certified Operator : ................................................... ............................................................. Operator Certification Number:.............................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 9 ` " Longitude • �� �46
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish (Dc) 1[] Non -Layer JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 3 ❑ Subsurface Drains Present ❑ Lagoon Arca ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
t�.No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. II'dischargc is observed, was the conveyance man-made?
❑Yes
❑ No
h. 1f 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
9No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
�fNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
*Yes
❑ No
Structure 1 SuIuuturc 2 Structure 3 Structure 4 Structure 5
Structure 6
Icicntifier:.......................................................................................................................................................................................................................
Freeboard (inches): �Q---�a 3� 5,Lt
5/00
Continued
on back

r
Facility Number: — Date of Inspection Printed on: 1/9/2001
5. Are 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
closure plan? ❑ Yes 0;(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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload `!
12. Crop type ► 1�2�.L'T"C Cn� e Sol\
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
n
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?
Re[Luired 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 fall 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?
No •yiOrA000s'o!' 00ficieoete ' •w*re nee$• OW69 this.AsIC, Y;oo ;w�ii-tee#iye 00 flutth$r
: correspondence: ahatif this visit: .: :
XYes )WNo&�,—
❑ Yes �]N0
XYes ❑ No
❑ Yes
XNo
❑ Yes
I" No
❑ Yes
10o
❑ Yes
N No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
O No
❑ Yes
WNo
❑ Yes J�wo
WYes ❑ No
❑ Yes li�No
❑ Yes C�No
❑ Yes P(No
❑ Yes k No
❑ Yes kNo
❑ Yes PNo
❑ Yes tNo'
7 `. P y ' ... „ , .. r ... ` .. 3 , 7` . 'r i az €�.1� -- '• a' �� Bs (..
r ifs
Comatents (refer tla'; yestiob If � Ex lam an YES.answers and/or anyrecommendi3tions or3any other contmen @
Use drawings of facility to.btitter explain srtitahons (use additional pages as necessary} p' ►�i fi F n�' w +t
R ` ` A
`] t�►-.see ,���: ,, +�� ,� .�, to � �� +-.� '►y �-_.r- � ►�
Sa t ��k "'Z
�a`�uw �� Wt"�-1 .'��--� �P�a�►=`` `�- CC►ti-I�.es�a>���—,cQ.
Reviewer/Inspector Name QQv� 1-� tom; t �, , r r
Reviewer/Inspector Signature: L � �111� C1 Date: 5/00

Facility Number:' — Date of inspection printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
0
liquid level of lagoon or storage pond with no agitation?
1
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
I 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
M No
Additional Cotnrnents:and/or Drawings:
k R) -W�Q- �'Q" I
" L3 10 \'
9� e
J
5100

Revised April 20, 1999
JUSTIFiCATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Numb r
Farm Name:
On -Site Representative:
InspectorlReviewer's Name:U'i-�Q
Date of site visit: —
Date of most recent WUP:
Annual farm PAN deficit: ,( pounds
Operation is flagged for a wettable
acre determination due to failure of
Part /I eligibility item(s) F1 F2 F3
v r Ope afion not required to secure WA
determination at this time based on
exemption E7 E2 E3
Operation pended for wettable acre
determination based on P9 P2 P3
Irrigation System(s)-- circle #['(hard -hose traveler, _2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system wlportable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
. a o
E4 75 /o rule exemption as verified �n Part III. (NOTE:75 /a exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part I - F1 F2 F3, before completing computational. table in Part III).
PART il. 75% Rule .Eligibility Checklist and .Documentation of WA Determination
Requirements. WA Determination .required .because. operation .fails :one of the eligibility
requirements listed. -below:
_ F1 Lack .ofmcreage_which-resulted in -over.applicationmf._wastewater(PAN) on -spray -
fie
ld(s):accordingio:farm'sdast-two:.years:of-vrngation-xecords:
F2 Unclear,-.tllegible, or lack of information/map.
F3 Obvious Feld -limitations -(numerous:ditches;failure:to:deductTequired:..__.
bufr'erlsetbackmcreage;-.or25%`oflotal.acreageddentified_in=CAWMMinbludes _
small;-irregulady-shaped.fields = fields:lessihan 5-acresfortravelers`or.less-than
2 acres for.-stationarysprinklers).
_ F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part Ill.

Revised April 20, 1999
Facility Number -
Part Ili. Field by Field Determination of 75%
on Rule for WA Determination
TRACT I FIELD TYPE OF TOTAL CAWMP FIELD COMMENTS3
NUMBER NUMBER'.2 IRRIGATION ACRES ACRES %
SYSTEM
�f
a.o
6
I 113,s
t
I .i3 I s
�S
�
I
I
I
I
I I
FIELD NUMBER' - hydrant, pull, zone, or.point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation'system. If pulls, etc. cross -more -than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER' - must be clearly delineated on -map.
COMMENTS'- back-up fields with CAWMP acreage:exceeding`75% of its total. -acres -and havingreceived less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & .1998) of irrigationTecords,-cannot serve -as -the
sole baSis-for requiring a WA Determ_inatioh.=Back-up fields -must -be noted in thee-commentzectionand must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
P1 Plan Jacks 1ollowinginformation:
P2 Plan -revision -may_satisfy75%.rule based on adequate overall PAN deficit -and by
adjusting -all field:acreage:to below 75% use rate
P3 Other (ie/in process of installing new irrigation system):_

'Divisionof Soil and?Water Conservation, :'Operation Review "r ,, � ; h 4€
,s E nd, W9 E E E E,E: ,13 3 a ' ! s 3.-d 4 ,., j f a.9 ..: si 1,:. _'_ t : # s€'3,ds.E< . ',�.>9ir, f !:. _.!E 'I M1rr• •_. E!E'-'i:t F:'i,�.1 !!aE °c 6 !.!s s� t.€ E :ak, ! p . a9��i t F E#1 { ' �l j i DiVI31Un of 50�1 and�Water Conseryatiuu COIi1p1111kCe IASpe€Ctloll� ke € E t I�Rr,,,�P �4 . K
XDlvlsion 4,*W ter �QUAltty,-;COmph&nCe Inspection, j ,� ! � ail
ru>3 E �.E . E r4 € ,',I € r OtI1er. �A ene .E.:O eratAOn Review"I'`�3E''' iJ € €t!`; "� !g j hu3ii h€,M t € <_ a E�g i% S I € FgE o� 1E i'8�� S,yy
t g'at-,. p .. ,.. a ru, ,
ffiRoatine O Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other
F_ Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted © Certified 0 Conditionally Certified [3 Registered JE3 Not Operational Date Last Operated: ..........................
FarmName: .......1..�a.............................................................................. County:....�..................................................
OwnerName : ................................................... ........................................................................ Phone No:......................................................................................
Facility Contact: .. Title .. . Phone No: ...................................................
Mailing Address: ......................K..­(
N
....... ..........................................................I................... ..........................
Onsite Representative: Integrator L�t�. ........................... ............................................................................ �k...................
Certified Operator:.................................................:.............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude Longitude
Design Current Design Current' ;•'Design;;. Current
„Swine! ," . r Ca city;' Po ' ulation Poultry Ca aci Po " ulation; vi,Cattle " ,.
,;Ca actt To 'ulation
Wean to Feeder JE1 Layer ❑ Dairy y
x
Feeder to Finish 9030 1 Non -Layer I Non -Dairy
�' ❑ Farrow to Weans
❑ h
❑erFarrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts €
❑ Boars Tota1'SSLW::.
Number of I;agoons ❑ Subsurface Drains Present -Lagoon Area Spray Field Area
HolilinPonds'ISo1rd,Tra s �� E ` g p i ❑ No Liquid Waste Management System I;
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Il' yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes CR"No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )( No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..............1. �.... .4....................................... ..... I., .......................
.....
3..................................................... g.................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes D'No
seepage, etc.)
3/23/99 Continued on back

Facility Number:, 1 — 9 w Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of zr app c tion? ❑ Excessive Ponding ❑ PAN
12. Croptyp
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
U. iN •.* la�,i6lis'oe d�flic}ehcies •V lUe 17Qt.ed. 00ri ft Ols.vislt; • Y.o0 ' ill •teOiye 06 fu>4ftf
COI'I'eSAOiifiCtICC. 8�4t1t t�tLS VI I . . . . . . . . . . . . . . .
klCJLr&- lu•yurawwl rr1:1 L'Rt/1Alll all, it3illlSWClJ nUWUISIIy,!l Cl UllllllCllLLduVl41 VP1dll�i Uu1Cl CUllllll
. -'. c _ _ . r l y. 3 - ` 1 1 - �+ tt t..fy
rawings of fac�laty�ta better:explain sttuar,lons (use ;addtdonal pages asinecessary.)
.. r.. !-, i. ri. 3 .. } I F F I ii
❑ Yes )KNo
❑ Yes �<No
❑ Yes 5�No
❑ Yes b<No
❑ Yes WNo
❑ Yes 1'4' No
❑ Yes X No
❑ Yes jj�No
❑ Yes XNo
❑ Yes D<No
❑ Yes VNo
❑ Yes KNo
❑ Yes XNo
❑ Yes %No
❑ Yes ONo
❑ Yes No
❑ Yes No
❑ Yes �TNo
❑ Yes No
❑ Yes No
❑ Yes XNo
(Gt)
kQ G� aZ,e
Reviewer/Inspector Name 4' t q',¢� II 3 �jQ •"{ n
?C, a
Reviewer/Inspector Signature: �` Dale:

Facility Number: —6S9 J Date of I nspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 9No
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 kNo
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 9No
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
Additionaf-Uomments an
or rawings::,#
• �.., 4 Y r
I

r
Division of Soif and Water Conservation �Operati on Review
,
anon'.Compllance; Y, a t i r,
D pivision of Soil and Water ConservInspection ,
t
r
Division of Water Quality! Compliance Inspection
- ! y,
er Agency - Operation Review
13 othReview,
'
�
10 Routine 0 Complaint 0 Follow-up of DWQ inspection Q Follow -tip of DSWC review OOther
I IIYII II I
Facility Number Date of Inspection
,imc of Inspection / ds 24 hr. (hh:mm)
® Permitted ® Certified © Conditionally Certified 0 Registered 0 Not O erationa! Date Last Operated: P ........
Farin Name �Q�.... .�kQC�....AQA�. County:....I�� �?S!.A.�'o.....
............ ......................I.......................... .........
Owner Name:.. .L.......TR.CU........ .... Phone No: i a.. z. . '. .7.9. ,. ... ...........................
FacilityContact: ..................................................................... .. Title: ................ Phone No: ..........................................................................................................
Mailing Address: 4-� fo E 02 .�.tCl- LAf iD.S.*.....N �- ...................... Z �4-......G..o2.Y............K.......R.P.:........................ ........................ 8.............
OnsiteRepresentative: ........................................................................................................... Integrator:.PQ.6W9gD.... rAeN.;....................................
Certified Operator:...._(' 1A.j ....... t.A...... i-kc).7............. Operator Certification Number: ! S 3,.
Location of Farm:
....Aee4.Qn..,.... al=..... q4.Egs.ggY... C.go.55.�g 4.5.. ....S..R...l. S...................
............................................................................................................. I ............................................. ....... _ . ....... ....I... T
Latitude ®• 5Z j �'° Longitude t T r t•F 34 10
Design Current: ; r Design.. Current. Design, Current
Swine , Ca acity Po ulation Poulty,l, � Ca acity ,,Po Population. Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
QQ
❑ Farrow to Wean
❑ Farrow to Feeder
® Farrow to Finish
p
a "Jr
❑ Gilts{
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer 1 1❑ Non -Dairy I3
❑ Other
Total Design Capacity ia3D
'Ii ibtai'SSLW' 89,23.
;Number of,Lagoons 10 Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holding'Ponds /Solid Traps � ,❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
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/thin?
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): ..........�.. .............. I..........1.l......................... ..............................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes, brNo
❑ Yes (f No
❑ Yes No
Structure 6
................................
❑ Yes j No
Continued on-- back

Facility Number: (�� — S'� hate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes tElNo.
(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 1�l No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ElYes L` No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Q,Io
Waste ADDHOitlOn
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ENo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
ELM
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
;jLNo
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
CX4o
16. Is there a lack of adequate waste application equipment?
Required Rec6rds & 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?
(iel 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 reviewfinspection 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?
�io vioiafitjris or• d, flep"fites -were :rtQteo.il(rririg4jMs•visjt:• Voir ;will•f.ebt ive 06 fut1bl r:
corrisp6zidehce. abouf this visit. -
❑ Yes fKNo
❑ Yes 5�No
Yes ❑ No
❑ Yes M10
❑ Yes P�No
[]Yes INo
❑ Yes 0 No
❑ Yes KNo
❑ Yes lANo
❑ Yes R,No
Comments (refer to questidn #:.Explain any YES answers and/or any recommendations or any other comments s' r
1 , 1 i w, E. e i f{-1i• E ! ! �i;F: C E i 7.C,.pE
e
Use,drawingss of facility to:better explain situations (use additi6nal'pages as necessary)
3�
U,pQArrc- v ro S 4p t,..I curr t_nf- d-yAZ o�1cr--i-1e-71 o F ro_e A-- +0 rl i71S 1�
WUP
n M o rq-al jay rare F GM G2C �N�-j �2C�S,ao� A74*-/ ' aA-t- s,7
'T
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 11 //p
3123/99

I
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 at/or below
Yes
NI&o
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
[:]Yes
Pq No
29.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
A�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
&0
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
*0
32.
Do the flush tanks lack a submerged fill pipe or a pefmanenthemporary cover?
❑ Yes
RNo
.Additionalomifients �an or ritW1I1 ar � �i �� �-_ t r � • �� l
J
3/23/99

4
Lagoon Dike Inspection Report
Name of Farm / Facility Hal Trott(Double T Hog Farm) 67 - 57
Location of Farm / Facility SR 1229 Lagoon # I _
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Sq. Ft.
Upstream Slope, xH:1V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
HaLTrot. 426 Gregory Fork Mad,
Richlands- NE 28574 . .
9 / 28/ 99 Names of Inspectors Zahid Khan
. 0 Freeboard, Feet 15 Inches
95.625 Top Width, Feet _0
In Ground Downstream Slope, xH:1v to I -
Yes X_ No
Yes X_ No
Yes X No
Yes X_ No
Yes X No
Yes X_ No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
If Yes, Depth of
Overtopping, Feet
Yes _ X No
! Woon # 3 by a gycEa . , •IL
:►
ot

,it
Lagoon Dike Inspection Report
Name of Farm 1 Facility Hal Trott _(Double T Hog Farm) 67 - 57
Location of Farm 1 Facility SR 1229 Lagoon # 3
Owner's Name, Address Hal Trot_ 426 Cgegory Fork Road,
and Telephone Number Richlands_ NC 28574 910-324-4797
Date of Inspection 9/28/99 Names of Inspectors Zahid Khan
Vincent Lewis
Structural Height, Feet 10 - 12 Freeboard, Feet 14 Inches
Lagoon Surface Area, Sq. Ft. 58,000 Top Width, Feet 4-5
Upstream Slope, xH:IV _3 to 1 Downstream Slope, xH:l.v _.1.5 to 1
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes }
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Yes -- X _ No
Yes _ X No
Yes T X,_ No
Yes _X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes _. X No
Other Comments Lagoon # 3 needs to be p-u ped down up to the
Required level. __

x
Lagoon Dike Inspection Report
Name of Farm / Facility Hal T>R'Q ouble T Hog Farm)-67 --57
Location of Farm / Facility _ Sly, 222 _ Lagoon ## 4
Owner's Name, Address Hal Trot, 426 Gregory Fork_ Roach
and Telephone Number „ Richlands- NC- 28574 910-324-477
Date of Inspection 9 / 28/ 99 Names of Inspectors Zahid Khan
Vincent Lewis ,..�
Structural Height, Feet 5 6 Freeboard, Feet 30 Ind es
Lagoon Surface Area, Sq. Ft. 6 0�, OQT_ Top Width, Feet 4-5
Upstream SIope, aH:1 V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes }
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
4 to I Downstream Slope, aH:ly 2 to 1
Yes X_ No
Yes - No
Yes X No
Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes _X No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes --X--_ No
Other Comments

-,.:
,..�33 ,3. .- ' a``YS.''0.�d.w.:p, °' ,; ;.,. .:.
� ..:., .....0. 4k,.».,,W:�f- .::
,m"z -.. -
° •` -
x °,`°' 0 Division of Soil and Water Conservation
13 Other Agency"
aka s
ivision of Water Quality
:,
Routine O Cum laint O Follow-u of DW ins ection O Follow -a of DSWC review O Other
Date of Inspection 4 ?�
Facility Number
Time of Inspection 24 hr. (hh:mm)
[] Registered AEertified 0 Applied for Permit 0 Permitted 10 Not Operational I Date Last Operated:
Farm Name: County:...........`.` ....................................
OwnerName...... ........................I............................................. Phone No:................t.. .., 7.............................
FacilityContact: ........................... Phone No:...................................................
Mailing Address:.... P... ....... .�— ................ ....... .........JI" LC Y /-!';........... ............. ...........
Onsite Representative:....,fL....................... x....` ...... Integrator:... . ..................
N
Certified Operator:......... 1 ;..� ...................... r1%j!....:2 . ....... Operator Certification NEtmber;......................
Location of Farm:
0C
C
Latitude 0• 06 46 Longitude • =1 ="
�m1. Design ' Current x
Design; - Current`` Design'Cncret
Capacity
Poultry, "Capacity
Population Cattle Capacity Popu. WR
❑ Wean to Feeder`
,Population
❑ Layer
F
❑ Dairy
❑ Feeder to Finish
�'
❑ Non -Layer
❑Non Dairy
❑Farrow to Wean
❑.
Farrow to Feeder"r
❑ Other
arrow to Finish
('
Total Degign'CapacityY
❑ Gilts
b
❑Boars
Y
otal SSLWF
Nunbroflvi4ns l,Holtitn4�g>,Ponds
® ❑Subsurface
Drains Present ❑ Lagoon Area ❑ Spray Field Area
y i l ttR��k •sfz,:
4 a Ti
'10No
SSA.`K ih
Liquid Waste Management System a i
,
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes RNo
2. Is any discharge observed from any part of the operation? ❑ Yes Y.No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ZNo
b. If discharge is observed, dill it reach Surface Water? (If yes, notify DWQ) ❑ Yes ZNo
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 „RNO
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ANo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 1.19No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 9Yes 91 No
maintenance/improvement? 00�-'
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 1AjNo
7/25/97

Facility Number: 5
6.
Is cility not in complian h any applicable a criteria in eff at the e of design?
es
No
7.
Did y fail to have a certit doper, r in responsi e ch, e?
❑ Yes
No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
0 No
Structures (Lagoons agoons and/or Holding -Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
ONo
Freeboard (ft): Structure 1 S ucture 2 Structure 3 Structure 4
Structure .
Structure 6
ri
10.
Is seepage observed from any of the structures?
❑ Yes
5'No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
4No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
ONo
(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
® No
M' Ie ApVlication
14.
Is there physical evidence of over application'?
❑ Yes
["No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15,
G f �
p type . .......
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes
14No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
R'No
18.
Does the receiving crop need improvement?
❑ Yes
Jallo
19.
Is there a lack of available waste application equipment?
❑ Yes
0 No
26.
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
J4 No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes E�No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? �o
24. Does record keeping need improvement? RbYes ❑ No
r ,ems'
Reviewer/Inspector Name • , "� x,,<�
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Routine O Complaint O Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
FacilityNumber
Date of Inspection 7 Z 9
' �7
Time of inspection � 24 hr. (hh:mm)
Total Tinie (in fraction of hours
Farm Status: ® Registered ElApplied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted lor Inspection includes travel andprocessing)
❑ Not Operational Date Last. Operated : ................ .................. ..... ........... ........................ ....... ........ ..».... ........ ................. ...............
FarmName �. �........................................uPa .. C............... ....... ..... � Caunty:.....r!.S.l.a.`t.............................
LandOwner Name:.... .................. —.......... _............. .................... Phone No:...a .` ...`.. ?r g7...........................................
Facility Conctact:..... k4.4..L..............1 2 d. ... _.............. Title: .QW..M L.................. Phone No:..........................................................
Mailing Address: ..... .�»z,, .II...,? Gd.»......Q{e......ZA..........I PS _........... Z...`......
Onsite Representative:......i L^................. ................ ......... »........ ..... ......... ._....... Integrator: » 9.N!`�.7-.Ip•»..............,......................................
Certified Operator: ...A L :............... .............. J,C 2D -77 »........ ..... ...... Operator Certification Number: ..�.»g............... ..,
Location of Farm:
Latitude �•� ®��
Tvne of Operation and Design Cavacit
Wean to Feeder
Feeder to Finish
❑ Other
Longitude ' 6 ®"
u
rface Drains Present
n Area `i. Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 2'9o-
2. Is any discharge observed from any part of the operation? ❑ Yes U-No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [ <0-
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑-90'
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 01,70
3. Is there evidence of past discharge from any part of the operation? ❑ Yes [Ko
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑/Yes M-No
5. Does any part of the waste management system (other than lagoons/holding ponds) require E,Yes ❑ No
4/30/97 maintenancelimprovement?
Continu n back

dra6ility Number:........ .......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
truch[gs (Lagoons and/or H911 dins: Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
1.... ....... ........ ............. .........:5.......... ..
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Amlivatip.n
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .f. 45... ......................
❑ Yes ❑-No
❑ Yes ErNo
[g-'?es ❑ No
G-les ❑ No
Structure 5 Structure 6
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/Inspcetor fail to discuss review/inspection with on -site representative?
Eor Certified Facilities OHlv
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP7
24. Does record keeping need improvement?
❑ Yes [31` o
[9-Yes ❑ No
❑'Yes ❑ No
[awes ❑ No
❑ Yes O-Ko
❑ Yes Gi Ko
❑ Yes [J Ado
[I yes [WO,
❑ Yes UNO
❑ Yes
❑ Yes Ck
X0Ye No
No
No
Comments,.(refer to: question='#) Explai&any YES answers`andlor any recommendations or any,other comments. ,
Use drawings of facility fio better explain situations. {use additional pages as necessary) k
£s::xs♦ �+. a `.`'��' ! t: S ..✓ - .... ' a
mci 1.45 � S �:� -Ttitr r'LaciVp F 3'ei�C V P.. 41+PtP.
A10P CO l(t LY' 5isi- C04LE GagFA.)ey 14,[£A wLIi
t/air7Ntc�2`Z P2a�(Lw�S
Cdu L. s4 L1%YOXtJ >t f4V C1J-
L A D DP- i SSS�(>. Rz a a_
3t 2W o uATED -ra
. • h
Reviewer/Inspector Name � •
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Atten 'DIP. A10.
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: zS , 1995
Time: b
Farm Name/Owm
Mailing Address: -
County: ON s L oc J
Integrator: Phone:
On Site Representative: Rugg i -r9p7T Phone: _ 3aq-5-,50q
Physical Address/Location: I n_ S,2 /oia?g l9PPe-ex, 0, 3 _/l��lh 5E Q/�-- as cizarr erg
Type -of Operation: Swine Poultry Cattle
Design Capacity: 7yd 15,-w_t, Number of Animals on Site: oDc7
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 S a ' �5 �' Longitude: 77 Of�7u Elevation: `�4 ' 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 or or No Actual Freeboard: Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or'No Was any erosion observed? Yes r No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes c --
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? j' e No
100 Feet from Wells? CLe � or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o Na
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes qrN
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ctNo If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
litional Comments: (Ao P.y' (,rb rD DcJ�_7-fz_
sA�_w/_s.
Inspector N
Signature
I
c: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fax:[phone] Jul 25 '95 7:29 P.12!17
Site Requires Immediate Attention -lip
Facility Number: i,T--:!:Z
; :i
SITE VISITATION RECORD
DATE: ,ram t r r ? 1995
Owner: ,4"AL 7-Aoi r Farm Name: 4do e4 As4,,f .pro c rW •r 4••.
County: O~j
Agent Visiting Site: /VA« - Phone: al-e rrr-Yr�i
Operator: �, t _1--,r.l-i . _ - Phone-,. t r1 +1,_, ,r.r C, S-r-of
On Site Representative: evi 4 r.� i r Phone:
�PhysIcal Address: 0-v rt 4z z.9, .we, S..s.00c"O .aldZ eFe,&^y C. ±.-f 1.o4*r
& w. Tl,�.c �' 1'k re s.r e� r owe,' X "Ll—
Mailing Address: 9 2 ttuaman f
Pic
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: o Number of Animals on Site:
Latitude: 0 ' _ Longitude: c "
Type of Inspection: Ground Aerial
0
L�
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25, year.24 hour storm event
(approximately 1 Foot +8 inches) or No Actual Freeboard: 4 Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
continents section.
Was any seepage observed from the lagoon(s)? Yes or Y�Was there erosion of the dam?: Yes or 1�
Is adequate land available for land application? XeQr No Is the cover crop adequate? �r No
Additional Comments; I Zae eo*,-f .? - 4.t. .�',= .���.� w , " d ��•+�-r
Fax to [phone]
Signatdre of Age

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SOIL SURVEY OF ONSLOW COJNTY, NORTH CAROLINA — SHEET NUMBER 14
HOFMAN.N
FOREST
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1 3/4 112 1/4 0 1 2 MILES
O v 0 1 2 KILOMETERS
SCALE 1:24 000

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shcpe 34 sq ft
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PRISM❑IDAL METHOD
❑R16INAL SURFACE ❑RIGINAL SURFACE
FINAL SURFACE LAGOON 4
CUT C❑MPACTI❑N FACTOR 0,00
FILL C❑MPACTI❑N FACTOR 30,00 % SHRINK
RAW CUT VOLUME 14322,10 CY
RAW FILL VOLUME 135,94 CY
CMP FILL VOLUME 95,16 CY
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