310802_INSPECTIONS_20171231

NORTH CAROLINA
r _,�
department of Environmental Qual

type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
treason for Visit: X Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: l(1 Region: 1
Farm Name: tvm Owner Email:
Owner Name: _4t.j Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
V1 I I
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: "t l 2 2,04
Certification Number:
Longitude:
Design C►urrent
Swine C•apaelty Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
C**urrent
Dry Cow
Farrow to Feeder
Farrow to Finish
Dr, P.ouItt, Ca acit P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Other,Turkey
Other
LjOther
'Turkeys
Poults
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 V No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

]Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes {KNo ❑ NA [3 NE
(i.e., large trees, severe erosion, seepage, etc.) �1
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
rV1 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
kNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): . /' (C"o
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
9No
❑ 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records &_DocumentsRecords &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2 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 �VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections []Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [?UNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Factlity Number: -6 U Ok jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�(No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C� No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes lkNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [�&A 0 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:
❑ Yes LNNo
❑ Yes PVNo
❑ NA ❑ NE
❑NA ❑NE
❑ Yes CgNo ❑ NA ❑ NE
❑ Yes [X No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Ciimmerits'(refer..to°que'stion #,}gEExplitinany YES'ans�wersand/oirgtiy itddltiaiialreco'mmendittionso`r"ariy other:co_mt"tien"ts. ?
t:�t,: y ..7AA*.f{1.>'.34 A - 0fj% 'UA"J ti f#7..�sf :j'j�t:�.34 z:�it.r ic�r,3 3k011 : �";- .__.` :.� .t
se draw,in�s,of facility toabette.r ex.Ihiifsi.tuati6ns�(use:a..dditi6iial palzes asxnecessary)� ; ; � ' ys� r U M. .:"
I06qk cud � Cu,rM,E- PeA(W�� W CSC, vn records
bVW44 Wak 6L8j J,D
PMf KI WA
3 — IR-Q2s �nwrKd- �AtJ rc�4e � ��zz�i�, q�Lln
-
`'�D
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 011 U _11 w— r 3Q
Date: 2S
2141201;

Type of Visit: (D Co pliance Inspection O Operation Review (D e Structure Evaluation 0 Technical Assistance
Reason for Visit:. Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: q,-13f] Departure Time: County: 0VJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: nn�� ,,,, ,,,, Title:
Onsite Representative: Gc—"y I4d,g C-.Y Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number: q99-0-0
Certification Number:
Location of Farm: Latitude: Longitude:
Design C►urrent
Swine Capacity Pop.
Design Current Design
Wet Poultry Capacity Pop. Cattle city
Capa
Current
Pop.
Wean to Finish
Layer
Dai Cow
if
Wean to Feeder
I INon-Layer
I
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D P Poutt Ca .acit P,� .
Dai ILeifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ N E
❑Yes YNo
❑NA ❑NE
Yes ❑ NA ❑ NE
❑ Yes �/o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Faclli 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? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: "trc Sn/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): So
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 ZNo ❑ 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? dyes [:]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CZ/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 940 ❑ 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 VNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes YNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes PNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes Z�4o
LZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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 ffNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number; 1 - 30 o
jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes IYPo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z"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
u 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
Ef�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
C2"N' o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
YNo
❑ NA
❑ NE
Comments (refer to,que's��tiod #):FEzplasn anyY,ES$answers`andloranyadditional:'reeommendations of any other comments.:
Use drawin s?of°facilit`'to better;ez lainesitui ti6&s (use;:adaitfori011 a ges as,nece spar
Yz. ,..�� _._,._ q �. _{ - . p_g - ys) i.....
1) ftk 'PUPAL OUT S-
Reviewer/Inspector Name: all N
Reviewer/inspector Signature:
Page 3 of 3
Phone U476
Date: , Ib, /1�
1214,4015

V�
Z
Type of Visit: U CC Hance Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:=u--� Arrival Time: a o o Departure Time: O r ] County: D� n r Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: r ( /►� r Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
4
Z v0
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Drry P,oult . Ca aci P,o
Layers
DairyHeifer
D Cow
Non-DaiEX
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
j(� 1
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑YesNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: rUate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [ONo ❑ NA [] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes []"'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Ej No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CfNo ❑ 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 E✓(No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes d 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 2<0
[—]Yes [�rNo
❑ NA ❑ NE
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[fYes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[TNo
❑ 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
El o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[v] No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

■
Facili Number: - p Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3"'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? bYes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No ❑ NA 61NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E 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 CA.WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-sitc representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes dNo
❑ Yes nNo
❑ Yes E3 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA
❑ Yes �No ❑ NA
[:]Yes No ❑ NA
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature: Date: 1
Page 3 of 3 2412014

(Type of Visit: O ZRoutine
pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 3d County: 7 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CIA LQ 1446U�-:(
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design C►urrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
6 0
Non -La er
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, Ploultr.
Ca aci
P,o �.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
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)?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes FIN
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 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
Structturef 1 Structure 2 Structure 3 Structure 4
Identifier: tAkeo'l✓
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
CO] 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
n 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 env' onmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Io
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
hTo
❑ 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
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�Zo❑
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes g2o
[] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

I /.
Facility Number: - Date of inspect —ion. S 5
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6 No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [Z/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 [:2 N ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes �o ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.::
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ( 11C — S
Date: -3) S_ I V-1
2141 011

Type of Visit: Q Com lance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint 0 Follow-up Q Referral 0 Emergency O Other O Denied Access
Date of Visit: 44,
Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: �CrZA ! i y 6 a e-(,4) Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
01
11_aer
Wean to Feeder
06
Non-L
Feeder to Finish
Farrow to Wean
Farrow to Feeder
rrfNon-L
Farrow to Finish
Gilts
Boars
Other I I IMI (Other
Latitude:
Poults
Phone:
Certification Number:
Certification Number:
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?
Longitude:
_Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
t �J
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[Z/No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes �17No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWQ
7. Do any of the structures need maintenance or improvement! ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes eNo ❑ 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
❑ 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
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No NA ❑ NE
the appropriate box.
❑ 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 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi ❑ Yes Vo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes;70 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document] Yes o NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 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 WNo ❑ NA ❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes /Nc/ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA [] NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question # ):,Explain any YES answers and/or- any. additional recominendations'or, any -other comments
Use. drawings of facility to better'ex lain situations use additional. a es as necessary).,
"
g tY p ( p. h Y)•
Reviewer/Inspector Name:
Phoned M/1 /7h
Reviewer/Inspector Signature:
Date:
Page 3 of 3 / 2/4/2071

Type of Visit: (25 C pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time: County:912 p Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /+ ,,nn Title:
Onsite Representative: t� 2^ #ZALb n4jK LEE
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: '?q ')_abl
Certification Number:
Longitude:
Swine Capacity Pop. Wet Poultry Capacity Pop.
Design C•ur:rent Design C►urrent fF
Wean to Finish Layer
Wean to Feeder Non -Layer
Design Current
Cattle Capacity Pop.
Dai Cow
Dai Calf
Feeder to Finish
en
Dr, P,oultr Ca aci P,o P.
Layers
Dai Heifer
jDry Cow
Farrow to Wean
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
fu-key Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes To ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes VN
❑ NA ❑ NE
[:]Yes
❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: ME Date of inspection:
Waste Collection & Treatment ;
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
12fNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑'es
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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
U 1V
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
o
❑ NA
❑ NE
(not ann icable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes C j o ❑ NA ❑ NE
❑ Yes No ❑ NA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ 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):
❑ NE
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FNo
❑ 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
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
ZNo
[] NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:)Maps [] Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] Yes [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. t ❑Yes o ❑ NA ❑ NE
25. Ins the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes CNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C34410 ❑ 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, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storagc 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 bd "o
❑ Yes No
❑ Yes To
❑ Yes
❑ Yes
❑ Yes
LJ
0'`'
No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional=recommendations one any�other comments t
Use drawings of facility to better explain situations (use additional pages asp necessary)
Mogl-roft' PPTC�cs dv 44&w
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: t — '7d
Date: -3144 Z_"
21412011

a -aa-ser
Division ofrWatertQuality
% #dr
,� f� l ��'' r� , `ds rs `€�,+I�.
k�aeiltty. Number ° 3l $03, O 1)Ivision of soil and Water Cbnservatao9n
,Other.Agency
��a,.�.�' i.'i'dXx".� :�`f•'».ra!t.£s<�.d. g:Cs,',�;..P'.�.��fl�''�'}'£�•�.�a�-.,tir,�t.r.,, -�d ��. 2t,�.
Type of Visit mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i 30 Departure Time: County: D V PL10 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ts(-_2i-u\ ft4t) L_Z"Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = n = ` =" Longitude: 0 ° ❑ 4 = {1
t., a a I ap :f r....�, / � 1 � � r �i$.3'�: Y.�',i2 t,yi�' �7 8-�Y,° r K
Design Current _ Designs Current�y F. �` g"'
", f g g p f '�. ? r parr f j , r aT , a -� f . : t �� Desl RI .CllPYent .a
Swine` „C,apacity ,'Population _ $ ;Wet, Poultry �` @apacrty Populah�n` Cattic C panty Pop lation
..� <.3: i ra..a-":-.sr-rx��rr: - :.. t.r ;. rTA#ru�ixaba s.R.�Po a.a�s:x.�e -.
1 >
El to Finish ❑ Layer ❑Dai Cow
® Wean to Feeder J]❑ Non La er I❑Dai Calf
❑ Feeder to Finish ❑
Dairy heifer
❑ Farrow to Wean DryPoultry�� " ❑ D Cow
❑ Farrow to Feeder ❑ Non -Dairy
_ El Farrow to Finish ❑ Beef Stocker
a_
❑ Gilts F I El Beef Feeder
f ❑ Boars ❑ Beef Brood Cow
`Oticr" �,�zr
❑OthI��ixs
r �'Numberof Structures I�
is .. ,r• ,,���-----,"aT. r-n v.�t.i n'.� ;3d . ❑d.�i;s Cir.��.t�,�.C.��i ��•>"F &" ��-
er E
La
ers
El Non -Layers
ElPullets
urke s
urke Poults
ther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
El Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
El Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
,L�JN� El NA El NE
El Yes L�1Vo ❑ NA ❑ NE
12
/28/04 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm
storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA6401J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 136
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 VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes C No El NA ❑ NE
El Yes L'J No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,.l��(No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes [ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No El NA El NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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
El No
[INA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElL✓�J, Yes
N/o
[I NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,
[y
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
//No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�/s10
Li No
❑ NA
❑ NE
Comments {refer to question#};'Explain any YES answers and/or any recommenda'xti6n1 oi,"Ohy, othee toin''eliti:S�' ,
Use dl'aWI1lgS`ol faCility t'o better. explain situations. (use additional pages as necessary)'
i
T
Reviewer/inspector Name ° '"
` ' ': Phone: 9 �a 7 3 $g
:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 1 12128104 'Continued

Facility Number: 31 — U Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes t[J No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes [�/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ErNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LJ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes B No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
[]Yes [3*No ❑ NA ❑ NE
❑ Yes L2No ❑ NA ❑ NE
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [_I 1vo ❑ NA ❑ NE
❑ Yes M-< ❑ NA ❑ NE
Additional Comments andlor'Drawings:
Page 3 of 3 12128104

�L_j ; •
Type of Visit 7Routine
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: 5 )d Arrival Time: ® Departure Time: County: me Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 0.&LAx o vt3�J
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 o = I = Longitude: = ° 0 ` = 1{
Design
Current
Design Current Design C►urgent
Swine
Gap�a*crity
Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ La er ❑Dai Cow
❑ Non -La er ❑ DairyCalf
❑ DairyHeifer
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Non -Layers
❑Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other Number of Structures:
Discharges & Stream Impactsn
1. Is any discharge observed from any part of the operation?
❑ Yes
En No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAGCR>A-)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2/No
❑ NA El NE
[]Yes Ld 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 R(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 5No ❑ 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 2fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need- ❑ Yes C No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ld 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
'0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
dN 0
❑ NA
❑ NE
lb,
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
L2/No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
o
El NA
El NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
No
❑ NA
❑ NE
Comments (refer to question ##): ,Explain any,YES answers and/or any necommendattons or any othe.rc°rtaments
ti. '�3xYh "# Y -3'
Use; drawings, of, facility: to bettenexplain situations:' (us"
e additional pages,as necessary): V r. �, , a e r •� `
T
Reviewer/inspector Name `yd�f/,} r �,`
Phone: �-
9 3
Reviewer/Inspector Signature:
Date: —
Page 2 of 3 12128104 Continued

Facility Number: 31 -- 01 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes r7L:J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain InspectionZNo
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?
❑ Yes
U�10
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElI Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
dN o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
:7No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LJ 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?
El[ Yes
��
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
tNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number I 31 ` �6� 0 D€vision of Soi€and Water Conservat€on
----�-- - - 0 Other Agencv
Type of Visit 6 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other J❑ Denied Access
Date of Visit: EAOArrival Time: O Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 66iz. LD (.ORL y
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
n°
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
` �" Longitude: = o
Design Current
Desig'k n Current
Design Current
rswx.ne
Capacity
Population
Wet Poultry Capacity Populat€an
Cattle Capacity Polat€on
Wean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
W(No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[�No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number; 11— l" Date of Inspection
i
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ 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 &ya-J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ZNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[7No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[ZNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes
�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
dNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes
allo
❑ 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
Z o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
2No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Comntcnts (refer to,quc'stton,#) Ezplam,any YES;answers and/o;r�any r.ye��comnicndatio_ns or arty other�com�nenIs:
Use drurvtngs aTfacility to;lietter explains,ituahons ;(use addthonald�pages,as necessat.,,,. ��
'tdt..,n' 9.�$
S1JS�EGkr-4 A-) 0�
Reviewer/Ins ector Name 7`'1% -- 2�
P J 0 4N � Phone:
Reviewer/inspector Signature: Date: a
Page 2 of 3 12128104 Continued

Ga
Facility Numocr: — -1 Date of Inspection 8l o
� Required Records & Documents Sl1tjb9
. 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes do ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 7No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate bo below. 2(Yes [-INo❑ NA ❑ NE
❑ Waste Appl' ation ❑ Weekiy Freeboard El Waste Analysis soil Analysis El Waste Transfers ❑ Annual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IJ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit'? es ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? Wyes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes EJ No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes JN o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ElYes ON o ❑ 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 WNo ❑ 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 R No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes �'No ❑ NA ❑ NE
Additional Comments and/or Drawings: ;
Page 3 of 3 12128104

d 2--
Type of Visit
pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7Routine0 Complaint
O Follow up O Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: S 3 Arrival -Time: Z Departure Time: County: aA/St oi.J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ("��Lp y4C)OL-cy _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e =' = Longitude: = ° =' = "
Design
Current
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑
an to Finish
❑ Layer
El DainiSow
© an to Feeder 7,400 ElNon-Layer I
[I Dairy Calf
ElFeeder to Finish
El Dairy Heifer
ElFarrow to Wean
Dry Poultry
[I Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
ElBeef Stocker
Gilts
Non -La ersEl
❑Beef Feeder
FE] Boars
Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Puults
❑ Other
❑ Other
Number of Structures:
Discharees & Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 O/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 7No
❑ NA [I NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

)Facility Number: 3 1 —M Date of Inspection �f_I_ f o7iJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: C hA Cx0'cr'�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes C3"No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [3"No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes d No ❑ NA ❑ NE
maintenance/improvement? �
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ 2 Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I_J No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA
❑ NE
Comments (refer to question°#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of'facillty to better explain situations. (use additlanal pages as necessary):
fit,) (*f uP0AV_0 5fi0dsrz,,�, •
q 2a G g oSc u4 R0.
..�J
RReviewer/Inspector Name . Phone: RID G
Rvier/Inspector Signature: Date: 3 oy
Page 2 of 3 121ZcN1U4 4ontinuea

Facility Number: 3 — 8 6 Date of inspection 5 1 0
,Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes No ❑ NA ❑ NE
❑ Yes la'No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Applion El Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[I Annual Certification
El 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
�❑
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElO Yes
,El"NNo
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L3 NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
LINo
❑ NA
ElNE
lYYes
26.
Did the facility fail to have an actively certified operator in charge?
E
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E2 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
29.
Did the facility tail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10
❑ 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
,��,,��
12 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
�o
❑ 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
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Taciiity Number (Z O`Dtvision of Soil and Water Conservation
Q-'Other•Agency
Type of Visit 7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
ReasonforVisit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: S b Arrival Time: c3 Departure Time: County: 4011r Region:
Farm Name: Owner Email: _ ..
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: gc—ApLy I y�lo's 11
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = O = ` = Longitude: = o "
Design:° Current .Designs Current s Design-. b Current
Swine Capacity Populatror WetjPoultry Capacity ,Population;'. Cattlea ; tCap$city l'opulatton
❑ Wean to Finish
Wean to Feeder 26-6v
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars �.
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑Turkeys
El
Dairy Cow
El
Dairy Calf
El
Dairy Heifer
❑
D Cow
❑
Non -Dairy
El
Beef Stocker
El
Beef Feeder
El
Beef Brood Cow
- ----� <
❑ Turkey 1'oults
❑ Others Number of Structures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
[I Yes [I No [I NA El NE
El Yes [I No [I NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes d ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
12128104 Continued

(Facility Number: Date of Inspection
f.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1�/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structur 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 20 7
Observed Freeboard (in): ' ,j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes EdNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaiat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ElNA
[INE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [?(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes YNo ❑ 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
ffN ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
rJ No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N El NA
L�J'?
❑ NE
18. Is there a lack of properly operating waste application equipment
❑Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any;YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pagcsas: necessary)
So. (6ivP LIPOATE top 6 ao/J 061f4AIAL
i 1N� eCT P*'M0f1V6-S 1'(Zav'\ 1�61Zr't j� l7 SAS
Reviewer/Inspector Name Phone: /
Reviewer/Inspector Signature: Date: 3
Page 2 of 3 / 12128104 Continued

FacilityNumber: — Date of Inspection 3 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ N ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box b :alysis
. Yes ❑ No ❑ NA ❑ NE
❑ Waste A lic ion ❑ We kl Freeboard El Analysis Soil ❑ Waste Transfers ❑ Annual Certification
P� � Y Y
❑ 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
YN o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
7wo
[I NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El
[I NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
WN A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O/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
U 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
0 ❑ NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
VNo
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[INA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o ❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 6,C.,00 Pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit � Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S 1 L Arrival Time: ;L!7L I Departure Time: Cou
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: G£rr.Atr) (Wa A LE
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = e = 4 = u Longitude: ❑ o ❑ 4 ❑
it
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish I
❑ La er
❑ Dairy Cow
® Wean to Feeder ILW
1 10 Non -Layer I I
apairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beer Brood Co
El Turkeys
Other
❑ Turkex Poults
❑ Other
❑ Other I
umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes e"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I NA
ONE
El Yes
El No
[I Yes
ElNA
ElNE
ElYes
,L
No
❑ NA
❑ NE
12128104 Continued

Facility Number: ' — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 3No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
El Yes EJNo ❑NA El NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes L2"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 ❑'f io ❑ 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. ElE Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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
Vo ❑ NA ❑ NE
lI No ❑ NA ❑ NE
EX ❑ NA ElNE
LdNo ❑ NA ❑ NE
Comments (refer to question #): Explain any. YES answers and/or any recommendations or any other comment§::
Use drawings of facility to better explain situations. (use additional pages;as:necessary);`
Zg) OPDAm LAcytaN iD csx S✓v+� A'� `� S I�rc Cj',
+
Reviewer/Inspector Name �Wf 11 Phone: Clld 9
Reviewer/Inspector Signature: Date: O
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records &_Documen_ts ,�/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Ye Ed No ❑ NA ❑ NE
LAY
20. Does the facility fail to have all components of the CAWS readily available? If yes, check es ❑ No ❑ NA ❑ NE
Other Issues ,�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes LINO ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 044o ❑ 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 L`if�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 � ❑ 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;IWoo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑�QO ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Check lists Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
LJ No
❑ NA
❑ NE
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers
❑Annual
Certification
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections El Monthly and 1"
Rain Inspections ❑Weather
Code
22.
Did the facility fail to instals and maintain a rain gauge?
❑Yes
L�'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
LJ Igo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
❑ No
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
,i�'NA
LEA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT") certification?
❑Yes
❑ No
�A
❑ NE
al Comments and/or Drawings:
Page 3 of 3 12128104

- Division of Water Quality
r==�71=mber Y gQ . Division of Soil and Water Conservation
_3 0 Other Agency
Type of Visit QTompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ` ❑ Denied Access
Date of Visit: U Arrival Time: Q Departure Time: County: ��f!�16f Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ...de6L/d &L,-, -
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Title:
Owner Email:
Phone:
Phone No:
Integrator: 2&r " -
Operator Certification umber:
Back-up Certification Number:
Latitude: = o = I Longitude: = ° = d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
U ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LI-NO ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
LNo
❑ NA
❑ NE
❑ Yes
I' I No
❑ NA
❑ NE
12128104 Continued

Facility lumber: — U Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes "P-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: I
Spillway?:
Designed Freeboard (in): 1�
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �?No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes [:J-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �' o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,'No ❑ NA ❑ NE
maintenance/i m provement7
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZfNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or t 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Dritl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ frCm those designated in the CAWMP?
❑ Yes EINo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
-FNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination':
❑ Yes
�?&o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
s of , kF� .„ .y R:.�
Comments (refer to question.#) Explum�any�YES answersrftnd/orwany recommendahonslor anyAother comments z s u A;At`�
iJse.drawin s:of;facili to better re lain situations use ad`'d�taonal a e' s a nec'esssa � = �'} 4;#a . � m� t,
.w 1.-. �: I? _? h..�-+1d...i ,4.�-�+�ir#s"gip,°R y�.• ,�
Reviewer/inspector Name G `_ > Phone: �/-- 6�
Reviewer/Inspector Signature: Date: /z
12128104 Continued

Facility Number: 3 —$Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes _Lafilo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JZ No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes LZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 60 No
10 A
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
aNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes [Z No
I11NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
ZNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ;2rNo
❑ 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
'12'No
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes J2"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
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
,'No
❑ Yes 'LJ No
❑ NA
❑ NE
Additional Corr meni gndloriDrawinQps $ a
a o) v>I c1Q- �c�gQo,n d� s.5�., w Qjy\ st+�
reGord5-
C,/ tea!
�Gv
12128104

Type of Visit JOCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit xRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: If —Time:
Not Operational 0 Below Threshold
JoPermitted © Cyjffled 13 Con •tio ally Fertifiied [f Registe�gd Date Last Operatedyar Above Threshold: ......... ...............
Farm Name:
., County; ..... i .f-!''..............................................
Owner Name: . .1. !# :..:. ! g�l lrN.....�..L,. /.L �`'�jPhone No: ......................................................................... . ............
MailingAddress:........................................................................................................................................................................................... ........ ..........................
FacilityContact: ...................................................................... Title:................................................................ Phone No:...................................................
Onsite Representative:.4fx ............ �!.,C,>c ............................... Integrator:..... fi-aw
................................. ...........
Certified Operator: ................................................... ......... ................................................... Operator Certification Number:..........................................
Location of Farm:
PSwlne ❑ Poultry ❑ Cattle ❑ Horse ]Latitude ' ° " Longitude ' 4 cc
k< i.. ,..'s A:v PaP4iVYi
Wean to Feeder
;,A,
V
❑ Layer
❑ Feeder to Finish
❑ Non -Layer
❑ Farrow to Wean
❑ Other
Ej Farrow to Feeder
Farrow to Finish
i t i 4 -1 fAC'St 'Y �f 1
]� E '�' ,7,� r� tr�x,� .a. h � t � , � 1� � Flit
t �} -,, F N TOtaY Deli i
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes FrNo
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 gaUrnin?
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 PNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [-]Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes PNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: ........................ ............................................ ..................................... ............. ...................... ......................................................................
Freeboard (inches): l7
12112103 Continued

Facility Number: —06Z I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes ONO
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ZNo
&. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes WNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes gNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes ZNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes ONO
❑ Excessive Ponding ❑ PAN Elyiydraukic Overload ❑Froze Ground Copper andl Zinc
12. Crop type
13. Do the receiving crops differ with kose designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes XNo
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 VNo
16. Is there a lack of adequate waste application equipment?
❑ Yes r No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ yes 0No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [:]Yes INo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes XNo
Air Quality representative immediately.
Comiaiieats,/\refer.'`toy"uestioa #} Ex` larn'aa hYES rowers and/or any ecommendations or>�ti'y1'otl 'e`r'
. ,Sias:,.',.:=;..s.....su.-..Eu..;-,ti.:: i+sr5a�,eo.SU.€.,�iii,l�is3Li�Fs1 En
UseEdraivtbgs'af:facility to}beLterhezpla�n sitKu�attons {use additzonai pagesias necessary) :+, Field COPY ❑Final Notes ''E
(t�, `!
.� :w l
<�,i`f >d .�2?Pj �: et�it,3e 9�f�:.:4'-��ai�`':�u::E�63.ids:il'4�!!`u�`rq.eit,„�[?ti�ez �4. •i.�i.....h.�,.t xi �t�^ti'.ltiSa.�`ih?11..{ ...,.._ S1.u:.'f?L_,-�n .ao�i�...
�1 /t/Q
Ab
;i✓ 4c06Q. ) r i6vk 1�,000Z %R5 ;,��
Vvi
Reviewer/Inspector Name ; <,, �_ `:..' w'
§ � i a; � ' rT E� '1 j A { il j ,tii
ie�.xtix
/� s„ ,` ;� u aia SrdP. �..�, ,.t
Reviewer/Inspector Signature: Date:
12112103 Continued

Facflity Number: Z Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? XYes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes 2TNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JZ No
❑ 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?
❑ Yes No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes No
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes A
28.
Does facility require a follow-up visit by same agency?
❑ Yes XNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 7fNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes VNo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number j Date of Visit: dZ Time: �'
Not U erational OBelowThreshold
Permitted 19 Certified [Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: j/!u!h i+GbUl�`� l urA'L County: /t/t4k
Owner Name:
Mailing Address:
Facility Contact: y�,y Title:
Onsite Representative: . - e rkl d mil 1 ey
Certified Operator:
Location of Farm:
Phone No:
Phone No -
Integrator: h Integrator: �is/
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 6 « Longitude 0 6 �u
Wean to Feeder JjE3 Layer
ILI Feeder to Finish y ❑ Non -Layer
Farrow to Feeder
Farrow to Finish
No Liquid Waste Man
Field Area
Di c�h ra � se Stream ImUA t
1. Is any discharge observed from any part of the operation? ❑ Yes M,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? ([f yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection �Vz Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Stnucture 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 31 -462 Date of Inspection Z d
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 � No
(If any of questions 4-6 was answered yes, and the situation poses art
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 rO No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes N No
Waste Annlicati
10. Are there any buffers that need maintenance/improvement? ❑ Yes _1*No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [2 No
12. Crop type !&V41p A rt�Y4 z Oy6-feelf _.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Z,No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes (S No
a
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
[RNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
EN No
Renuired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[$No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
EN No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[!9 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [UNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 0 No
24. Does facility require a follow-up visit by same agency? ❑ Yes N No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes (I No
115 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
f3�#*Comieetoqueston #)F +pwcnses-n,,rokm....mi _. ents ?
„x .aa>.,;a
Use diaw3ngi,,9f facility tdlbetter explaa1in situations.,(use'raddittonal,pages as necesiary) ❑yield Copy ❑ Final Notes '
T"
"'�vi!.^
�e �_1/9: s� s,,� of e s-e� �o�t Is-t-170 , 1%� 'PA -WA e- 7'10 m•foAPe el_5; t,,
//: �i �V-S
fe, ej-p,&[ %DISK 9 lf71 /�J�l� l-�D >~C.i I� Ilk�.��O�a Ord GIrlrP✓ Wele ^sue
are 4�1 el e7e
[�aL�
/� '1
I /1 E' 1v/ YA- tie L� ✓e � A 6�� -�p I+f �L �fTN�I Ort � �� Z 1 !✓A5 !'es6 ,1# 7Yr�ss�?1 6il7Pr
vL°t1ILu
t�l G Wsed �- f rEc �re5u ��'nPrK�4t &sr�,) / �� s dlW had &a 5e RIP are, eeA, vee .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: `2
0510.3101 � Continued

i
Facility Number: 3 Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes P�LNo
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 &.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 L'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 0 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes (RNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes kNo
Addifionall Comments and/orDrawings:
east' Zvk-4 -
5/00

I I - r I
?� Divistori of WAter_.Quahty
utsaw'xifm S r h r R� p
D]Aslon of Soil and Water Conservation
r
yIQ Other Agency
�''t':�. �� Y F
f �.�4 is��' l,�J
1 Y' « ,�, I 3•.a.
:.' .'�.. ... .: � � rf
Type of Visit t3.Compliance inspection Q Operation Review O Lagoon Evaluation
Reason for Visit ZRoutine Q Complaint O Follow up O Emergency Notification O Other p Denied Access
Facility Number Date of Visit: 1 117,96rime: [� Printed on: 7/21/2000
Q of Operational Q Below Threshold
'Permitted Pkertified © Conditionally Certified J] Registered Date Last Operated or • bore Threshold•
�j� j� ]•.
Farin Name : ...............&.l%.�N,:..............!.!...k:Q6i.... ......... ......... ... ... County:........... 44 .............. .
..... .... ...... '
OwnerN:ime:............................................................................................ Phone No:.. it.�.V .Crl.. .1..... .................. �... .�..c .
FacilityContact: ..............................................................................Title:.,......................................... Phone No
MailingAddress:... ......................................... ..........................
.............. ........................... r
............
Onsite Representative:....�L��....... Integrator:.............. ...................................
it .. ... ......
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
it Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �� ��� Longitude �• ��«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder Ll<W JE1 Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean —71
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag,-n 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. 11" discharge is observed. what is the estimated flow in galhnin?
d. Dees 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
❑ Yes *0
❑ Yes ❑ No
❑ Yes ❑ No
r2
❑ Yes []No
❑ Yes }krNo
❑ Yes i-No
❑ Yes INo
Structure 6
Identifier: .................................... .
q0It
Freeboard (inches):
5100
Continued on back

- Facilit Number: — Date of Inspection 0 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obs ved? 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 R�0
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
&(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0
r
9. Do anystuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
&,blo
Waste Application
I0. Are there any buffers that need maintenance/improvement?
❑ Yes
j�No
11. Is there evidence of over plication?❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
PNO
12. Crop type SG
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
� 0
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
\ o
b) Does the facility need a wettable acre determination?
❑ Yes
kip
c) This facility is pended for a wettable acre determination?
❑ Yes
o
15. Does the receiving crop need improvement?
El Yes
f$\No
E
16. Is there a lack of adequate waste application equipment?
❑ Yes
I -No
Reauir•erl Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes 1� No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? '\
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ZNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes J$ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? [] Yes o
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes <N\ o
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �No
23. Did Reviewer/]nspector fail to discuss review/inspection with on -site representative? ❑ Yes ArNo
24. Does facility require a follow-up visit by same agency? ❑ Yes krN\ o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
.: Io yi6lavigris or deficiertcies -mere h6tea• during this'Asit! • :Y:ou will >ree�iye titi fuethgr \\
. -'corresboridentce: abQu>k this :visit. ' .
Comments (refer to question #I): 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):
1N .
t v
a
Reviewer/Inspector Name a i� v
Reviewer/Inspector Signature: Date: p

Facility Number. — Date of Inspection' Printed on: 7/21 /2000
Odra Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor hplow ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 1�o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yesio
roads, building structure, and/or public property) r ` .
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 9No o 31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �\\
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes bkd
5/00

�. Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility Q lie i'�U�. f —`�d -� �Cj •`
0& T,fk rQ A, l� to t/p.-L, S
C ea 9rocs /urn.�On
s/L/�•?� G/.^IS ^I1�5'+' f`
Owner's Name, Address
G{,ti �! ,'o F.n
Ler,1
d 1�$
and Telephone Number
L"' r. �� �q1(<
r e A)C
;Xqa pi`Z�o�a �s
Date of Inspection
o7
Names of Inspectors
CAAJIL)01
r
Structural Height, Feet
—
Freeboard, Feet
Lagoon Surface Area, Acres
Top Width, Feet
— /
! -
Upstream S1ope,xH:1V
Downstream Slope, xH:1Vr 1
_
Embankment Sliding?
Yes No
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Yes X No_ �j o
Yes 7L No
id ike vertop? 1 Yes i�-- No if Yes, Depth of Overtopping, Feet
:��.v�Ghnn�Oc�r
Follow -Up Inspection Needed? Yes No
EnaineerinQ Study Needed? Yes N•
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments k.L� e 1,✓41 '� 1-•
U
—Yes No
r

S�
i-� rr � .: •.�_': �7:� - - - :�s� .•* y : '+t�-rrr.�:�.... f.r. .�....'r:=;" -•:r: ;r.•r,•. •,�-,.•ter ; r.�: : r
.. - Sf , . ... ' i? .• r? •� , �,-'� 9�"•s.ti-, rv: rr, .ti+:•. '{S' . •'�:''v <�r:�: ;� � �:�:�� . 'vY' _ .. .

Facilit} Number Date of Inspection
'1'iine of Inspection ©24 hr. (hh:mm)
p Permitted p Certified 0 Conditionally Certified p Registered in Not peratuura Date Last Operated:
Farm Name: Broryn.&.Mohley-F.arm............................................................................ County: Duplin WIRO
Owner Name: Randall.h..Geratld............ Ilrraw.ja.n4i..Mobley................................... Phone No: 9.107IK5450a ..............................................
Facility Contact: ......................................................................... .Title: .. Phone No:
Mailing Address:.1.7..7.8..Cypxes.Cr.eck.Rd..................................................................... 1N.a11ace C............................................................ 2846fa..............
Onsite Representative: .......................................................................................................... Integrator: Marphy..Family.,F',arrxns.......................................
Certified Operator:G.er+a.ld..a .............................. Mobley .............................................. Operator Certification Number: 196.7.0.............................
Location of Farm:
axapn.. truquapiuu.>ta e... ... .an . gar.. a .on o. ylrness. ree ga... .rnnA. xaru rrypress. ree . a.. rrm......
m(mum-on.left......................................................................................................................................................................................................................................... V
Latitude ®•®� ®�� Longitude ©• ®©{
Design urrent . ::,Design . Current Design Current
Swine Poultry Capacity Population Y Capacity ��Populationa Cattle Capacity, .Population,
® can to Feeder
2600
❑ Feeder to inrs
❑ Farrow to can
❑ arrow to Feeder
❑ Farrow to Finis
❑ Gilts
❑ Boars
❑ Layer ❑ airy
❑ Non -Layer ❑ on- airy
❑ ter
Total Design 'Capacity 2,600
TotafskW, , 78,000
-�k- Number, ofl,agoons �j ❑ u surface rams Present ❑ agoon Area ❑ Spray Field Arca
l�aldtng,iPonds /`Solid Traps" ❑ o LiquidWaste Management System
-E:
Discbaraes & Stream Impacts
1, Is any discharge observed from any part of the operation? Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Colleetiort & 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): ...............24......................................................................................................................... .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23/99 seepage, etc.)
Cl Yes []No
Continued on back

Facility Number: 31 1 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[]Yes
[]No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ 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?
❑ Yes
p No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
p Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
p Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
p No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
p Yes
[]No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
1s 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
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
p No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
© Yes
❑ No
a: No.violntions.or. deficien-cies.weremoted11.11 :during.tkis visit. You -will -receive na. further.'.
. - . • .corr6pandenee AKoitt this:visit:: ::::::..... .
urricane rioya Assessment wan ULV t &
ient freeboard available. No immediate problems observed.
anon-DS W): Dike wall in tact, sufficient freeboard is available. Fairly good grass cover with some bare spots, observed no
ificant erosion of dike. No recommendation for lagoon at this time. Flush tank is in bad condition and needs to be re -designed.
}.�>r�as�eu�sE,r r�stsnz__t;i t F-dt ,�s .�.t s�.ls:u_e.. Ja+-�..n7r_Ps",r�.trrmm^x'#�'Fr4"'i"��f1rdt_•a 'rr nf�7� C ��r^� ";, �t�, 1rfti„e7Reviewer/Inspector Name rian7Gannon(DSW);,
Reviewer/inspector Signature: Date:

a 0 Division of Soil and;Water Conservation Operation Review,
II 'C1 Division of Soil and Water,Conservatioxi Compliance Inspection
XaneIipea yp
� O,ther Agency ..- O eratlOi1 ReVK?
,U�trs�i
r.,.•-1.,11-e M
D Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC.review 0 Other
Facility Number Date of Inspection / y
Time of Inspection E=24 hr. (hh:mm)
0 Permitted 0 Certified [3 Conditionally Certified 13 Registered 10 Not U erational Date Last Operated:
I -DFarm Name:......&'0wo C.!..! 1✓, ........ i .............. County:.........rv..............................1.��,
r r
Owner Name: , �C%%� Phone Na: ,,,, l
rI!t��l.1�........ 1�/.................�............ 9.. �5.�.�.....................
�.......
FacilityContact: ...................................................................... .... Title:................................... .................. Phone No:...................................................
Mailing Address: / 7 8.. rpeess,......�ef�......4........ ....... r/�1&61:,.e....... L!l ....................... ....... ....
Onsite Representative:... 6wa.... Nlev:e.... 1�..:..l�i !!� Ilttel;i:itor:........ lJi1P
... �...
Certified Operator: ...... ...,....�,......lf'fQ.L.......... Operator Certification Number:......? ..............
4cleAol..............
Location of Farm:,
Z.'g.0m. .....u-zv1.e... ,5......(.:1 .......... ....... A.4.).A... LWKI....... W..�A/........ U...:V ...
/1- 1......... ,� ,r�! 4 ....... ........5, .. ..l.............I.....................................................................................................
- -_.
Latitude ��� Longitude2L •
Design
Current Design
Current ,' "'
Design Current
„
Swine Capacity
Po u„ouCapacity
atteCa
Clation
Capacity Population!!
Wean to Feeder
Z&OLO
Q
❑ Layer
❑ Dairy
❑ Feeder to Finish
[] Non -Layer
I
I
JE1Non-Dairy
❑ Farrow to Wean
JE1 Other
❑ Farrow to Feeder
❑Farrow to Finish
Total ;Design Capacity
2�>
�
❑ Gilts
, .
:Total''SSLW
7�t�DD
❑ Boars
Discharges & Stream Impacts
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 Witter of Llle State? (II' yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Uycs, notify DWQ)
❑ Yes 9 No
[3-Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes &rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes MNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Cl Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..........70.N.......................................................................................................... ...... ................................................................
..........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0
seepage, etc.)
3/23/99 Continued on back

Facility Number: �I — Z Date of Inspection J 1
,6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4 6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 9. No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Analication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
XNo
12. Crop type rI? IJ GR-�S �"eeeL f L
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
WNo
b) Does the facility need a wettable acre determination?
❑ Yes
XNo
c) This facility is pended for a wettable acre determination?
❑ Yes
&AS"No
15. Does the receiving crop need improvement?
❑ Yes,
X No
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes' M No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes NNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
wYes El 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 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
24. Does facility require a follow-up visit by same agency?
❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
�Vo vi 'I 't ris :or deficiencies •were !n4{ied• d(Wing �this;visit: - Voir will receive 06 ru�er, '
corres ofidenCe, aba' U' f this :visit
Comments (refer to. question #)11 Explawn any YES answers'and/or any recnniinendations or any other cormments
ilE to_b! N ±x .: ' ' '. - : f ,.,
Use drawm s of face
g, 3 ty etter explain sttuahons (use add�honal pages as necessary} + t # b; s ;i
t., r _; r .a.
l9� ,5.�-ntinr-& aJA, ,rre_ IA/ 6A-6r, / 6v&�2 1Zo OAYI
, AI )6_)_6r2" 11✓lrylo fJ
g� )eu F A6& /O / r-iG p `aA Re a,71a14% 720
vj
F ••r-w wa-tw•• r•• r u t� Is {pws `� tW ri � i' ' r�ti'>..,l doi rll."f t1
A ato tr Reviewer/Inspector Name
pr`1 E ...v]
Reviewer/Inspector Signature: Date:
3/23/99

Facilify Number: — Z fate of Inspection
6dor .Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes X No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ATNo
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes Po
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ANo
3/23/99

Division of Soil and Water Conservation 0 Other Agency'
x
ualtty
Q Division Of Water
Routine 0 Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 2,.3 24 hr. (hh:mm)
© Registered 10 Certified © Applied for Permit ❑ Permitted 113 Not Operational Date Last Operated:
Farm Name: lr V......."�-...�D14�. '&! b fff .,.... r�4Yt'F� ....... ......................... County:....... 1.ir.:..................................... .......................
Owner Name :......... Rmx-V.......1.1.11........ 6e-.V-W.....N6.[jV1 ......................... Phone No:...��� �. .�` .'............,...............................
FacilityContact:................................................................ . Title: ....... Phone No:
MailingAddress:..... Z. .....61`` a.SSA.....L.KA�.....�l,.e�.:............... 1:........ I............ .......�t�ikl�.Q�.t....NP......................................... .2,$'44(.......
�1 Onsite Representative:....... G&a.......Q11b .......................................................... Integrator:...........
Certified Operator;............................................................................. .... Operator Certification Number:..................
Location of Farm:
1. ..... .c!tiS,...... �e ...b........ 5........ ..1....0 .......t�Y-�il -5......5,0.V....... n........!SK...1.. , -Z.....................................................I............................
.. .. PIf
Latitude ' ' " Longitude • 4 C 46
%Design ��Curi ent ', Design Current Design Currentat
,
Capacity Population ;; • Poultry, Capacity Population Cattle ,Capacity,..Population,
Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish . ❑Nan -Layer ry Non -Doi �
❑ Farrow to Wean
❑
Farrow to Feeder Other
❑
[] Farrow to Finish Total Design Ca�aCtty
❑ Gilts E<
El Boars
� .Total SSLW:�
�K Number of Lagoons /Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes ( No
❑ Yes 'M No
❑ Yes No
❑ Yes
0 No
❑ Yes
[)D No
❑ Yes
[� No
❑ Yes
[ No
❑ Yes
No
❑ Yes
[ No
Continued on back

Facility lumber: 11 — L
8. Are there lagoons or storage ponds on site which need to be properly closed'?
.Structures (La Loons llaldin Ponds Flush Pits etc'.
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3
Identifier:
Freeboard (ft): ............��a..,........
10. Is seepage observed from any of the structures'?
Structure 4
❑ Yes P No
❑ Yes No
Structure 5 Structure 6
❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑Yes 99 No
12. Do any of the structures need maintenance/inthrovettient'? % Yes ❑ No
(If any of questions 9-12 was answered yes, and the sitnation 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
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoffentering waters of the State, notify DWQ) _
15. Crop type ................. 417.ua......,...........51'. Ak.....Q1�"IIII.......................... ..... ............................. ................ .................................. ................ ,........
.........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)"? ❑ Yes -4 No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes No
y l
18. Does the receiving crop need improvement? ❑ Yes No
19. Is there a lack of available waste application equipment'? ❑ Yes No
20. Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'? ❑ Yes rM No
22. Does record keeping need improvement? Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes M No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Na
25. Were any additional problems noted which cause noncompliance of the Permit' ❑ Yes [ No
[� No.violations or deficiencie's.were'noted during'this visit..Y,o'U.W'ill receive no furtlier
correspondence ali.out this:visif.•.
Comments (refer'to question #) Explain any YES answers and/or'any recormnendations or any other cnn me�i
.Use;drawtngs of .facility to better explain situations.'(usc'additional pages as.,n.ecessary):
IZ- C04%,Aue. WarK,-) ors i}08 -c-
2,Z , rfo�Ti tW +via A �} 10.�tio-
7/25/97
Reviewer/Ins ector Name
p
Reviewer/Inspector Signature: AA , z—ff Date:

Routine O Com laint O Follow-up of D"'Q ins ection O Follow-up of DSWC review O Other
Facility Number 0
Farm Status: ❑ Registered ❑ Applied for Permit
Certified ❑ Permitted
Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
(ex:.1.25 for 1 hr .15 min)) Spent on Review
or Inspection includes travel andprocessing)
❑ Not Operational DateLastOperated: ....................... ........... ....... ....... ........................................... . ..................................................
FarmName:..... ...... e 1Cr1!4.........`............................................... County: ....... bjuplix...........................................................
Land Owner Name:......1 i 1.l.... r�.....IJ Y�a�5i.... ...................... Phone No:..dJ0&.Wnq5b.1...........................................
Facility Conctact:..... �ri o�ti........ &AO& ................................ Title:.....?r.�ixk4tY....................... Phone No: 5... 1 ►.............
MailingAddress: .... i3..1..... tSS,...... L.....U......................................... ....G.L:......... tl�...-........................................ Ift.'........
OnsiteRepresentative: t 1......1�C.k)..i.............................................................. Integrator:..... AG41............................................................
Certified Operator:.��:s...:.. d:.................... �: �R�t..l�.�l......................
....
......... Operator Certificati'on/Number: ���? �d...........».......,
Location of Farm:
k............. 2 ... .I ....4 n.. .....4t!L.........�i,... ..... i� S�.... Cacx........
.oh ........... ........fta:.... .....i........ ?��,.....4.:S...ryi.�a .....4n.... a t...: uls .� le �.:.............................. .
Latitude ®'' ®" Longitude'
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes W No
❑ Yes (d No
❑ Yes $I No
❑ Yes 1A No
❑ Yes No
❑ Yes 14 No
❑ Yes 0 No
E9 Yes ❑ No
Continued on back

Facility Number- .11....... —.. QZ...
6. ' Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Q1No
titr a nolding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 60 No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
......... ::i :5........ ............................ ............................ ............................ ............................ ............................
10. Is seepage observed from any of the structures? ❑ Yes Q No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes dkNo
12. Do any of the structures need maintenance/improvement? ® Yes [:]No
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
31'aste ;Application
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.
Crop type ......... �Li4S#u+......... r> 5............... I.................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
[Yes
❑ No
IT
Does the facility have a lack of adequate acreage for land application?
❑ Yes
&No
18.
Does the receiving crop need improvement?
Yes
'IN No
19.
Is there a lack of available waste application equipment?
❑ Yes
JQ No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
15�No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
DjNo
Eor
22.
Cgrtitied Eacilitigs Only
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
® Yes
❑ No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
%No
24.
Does record keeping need improvement?
Yes
❑ No
Comments refer to uestton # .`'Ez lam�an` YES answers an-d/or.an recommendations or'any other comments ,, "
Use drawings.of facility to better explain situations `{use additional pages as necessary)
5. E�sz�r` o�nca�.. an a�H Iti+ � s 5 be �'l�lrri �cSeea�ccj. 4
�Z• Q AaraNnJ +V1_ "er• oR 125om AA or o-kosi6+\ ay., OLo[w LkAx(i s%vo
6 Lai4, chi m rtvtdaJ. &arc, o�.Kos cw, od,,, KAII shovlj be ►n.SQedcd.
rb�Zz/z�j plan (�As 1o0i.t3 l,, \Oui1�tn �.i'lrJ Ut�va+labia q+ �(,W_ 4 tnS c rn.
.a
cc: Division of Water duality, Water Quality Section, Facility Assessment Unit 4/30/97