310847_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Type of Visit: (E) Co Hance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral 0 Emergency Q Other Q Denied Access
Date of Visit: + / Arrival Time: �j Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: L Title:
Onsite Representative: t� (it,` 4 (1
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: Z 2 r g 6
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
an to Finish I
Design Current Design
Wet Poultry Capacity Pop. Cattle C►apacity
ILayer I Dairy Cow
Current
Pop.
can to Feeder
109 Iron
Non -La er
EE Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Design Current Dry Cow
D , P,ouIt , Ca aci_ P■o Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application -Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
[3'l10
[:3 NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: J.Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes 0110�0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes To ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ETNo ❑ 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 El No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EJNo ❑ 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
ale
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L;J�Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ale
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3-5o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[E -No—
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ca-M65-
❑ 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
❑- 1�
❑ 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
E].Nt
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C3I o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: oe
24.- Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes %a ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Pl<o ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes El -No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA ❑ NE
go
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes rzo�oNA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional naees as necessarvY. m
Reviewer/Inspector Name: p.r +C Y n �'4, Y�(M fi K1 Phone: 1 1.0 T 0►0
Reviewer/Inspector Signature: Date: A44_z*
Page 3 of 3 21412015

Type of Visit: 0 Ca pliance Inspection Q Operation Review Q Structure Evaluation Q 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:�b Departure Time: County: ( V Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ,( et'tr
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
11
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 2� 1� �Q
Certification Number:
Longitude:
Design
Swine Capacity
Current
Pop.
Design u enta Design Current
Wet Poultry Capacity Pop. C*attle -Capacity Pop.
Wean to Finish
I ILayer
I
Dairy Cow
Wean to Feeder
QOI
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D , P■oultr, Ca acit P,o Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes fNo
❑ NA ❑ NE
El Yes ❑ NA ❑ NE
❑ Yes [ ] NA ❑ NE
Page 1 of 3 21412015 Continued

$ la 1
Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes d-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA
(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
waste management or closure plan?
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [g""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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aontication
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 U'<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ rNo ❑ 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 KO ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[f N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
Noo
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[Z
❑ 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
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
QWo'
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C; "'
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

[Facility Number: jDate of Inspection: I
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 [2/No ❑ NA ❑ NE
the appropriate box(es) below.
D Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F3"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 2-No
❑ Yes �o
[:]Yes dNo
❑ Yes C? N
❑ Yes �o
[:]Yes
eNo
❑Yes
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[DNA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES"answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as -necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signa
Page 3 of 3
tor

Type of Visit: d ZRoutine
pliance Inspection U Operation Review O Structure Evaluation O 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: L Departure Time: Ci 0 County: DURZ41L Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: t3a-.c-,,J-y�C,N��, . Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
'2 ONG
Design Current Design C*urrent
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish ILayer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Z ab I jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr, P.oult . Ca plaket P,o ..
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
1 keys
i urkey 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 No ❑ NA 0 NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
[:]Yes E(No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: -S Date of Inspection: CULIU5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 06 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: (A&Foi-�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
EYes
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
En 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
1;2<)
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E O
❑ 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?
1 l . Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
to
❑ NA
❑ NE
0 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
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ IOW
❑ 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
EKN
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CR'N�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
l 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
04
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
�,o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�FNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C ]ro
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑NA ❑NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[E]No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
O 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
❑'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E!fNo
❑ 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
C5"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
[B'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[g 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:pa>es,as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�0}-1
L_
Phok- fP
Date: L9 I
2/4/2 11 S

jType of Visit: C�Cgfnpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit:c,,[ Routine O Complaint O Follow-up O Referral Q Emergency 0 Other Q Denied Access
Date of Visit: 1p Iy Arrival Time: ®O Departure Time: q ap County:.j�IRegion:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ?t2x-k,6 f"=CN(a_L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: d p 14(o
Certification Number:
Longitude:
Design Current
Swine C+apacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
D . Pioultr.
Design Current
Ca aci PLo P.
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
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. Whai is the estimated volume that reached waters of the State (gallons)?
❑ Yes O/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes �No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: Date of Inspection: to 11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
nn
Observed Freeboard (in): p!�
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
2/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
�VNo
❑ 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
[2To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1240
❑ NA
❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Er 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 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [�lo ❑ NA ❑ NE
[:]Yes fNc ❑ NA ❑ NE
❑ Yesal<10�
❑ NA ❑ NE
[:]Yes ]jNNo
❑ Yes Q40
❑ NA ❑ NE
[DNA ❑NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

]Facility Number: Date of Ins ection:
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 WNNo ❑ 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 1_J o ❑ 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 dN o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes E/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 E2/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 El 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 ❑ NA ❑ NE
go
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better exnlain situations fuse additional naQes as necessarvl.
Reviewer/inspector Name
wA
Phone( (6-
Reviewer/Inspector Signature:
Page 3 of 3
Date: l
diq
/4 011

(Type of Visit: Q Coptpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: $ g Arrival Time: (a Departure Time: /Q County: TN.)9 UT$� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: Qf "T Vtur _ L' Integrator:
Certified Operator: Certification Number: 2.6!44(,
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
I
Wet Poultry
ILayer
Design
0v—acity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dat
'ry Cow
k
Wean to Feeder
1
jNon-Layer
I
Dairy Calf
Feeder to Finish
Dr; P,oulti.
I Layers
Design
Ca acity
Current
P,o P.
I
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Qther
Other
Discharees and Stream Impacts
dNo
1. Is any discharge observed from any part of the operation?
❑ Yes
[DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
go
❑ 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 Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: "
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 95
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L6 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 i 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 d o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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 VVNoo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes fNo
❑ 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 go'No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes �o ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: S$ 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2� No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[!� Yes [:]No
❑ Yes [;?(No
[::]Yes &No
❑ Yes 0 No
❑ Yes ;dNo
❑ Yes r] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes VNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional.recommendations orany other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). Y
a(„) kEEW CWki 4 F DIL. WMTfi lj�CCotLDS,
11
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214,12011

Type of Visit: ('Co pliance Inspection U Operation Review 0 Structure Evaluation U 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: g a County: QLR -_r Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: Saks -A ry1=Tc.N E(.A._ Integrator: /
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design C*urrent
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
on -Layer Dairy Calf
Dairy Heifer
Design Current D Cow
D , P,oultry Ca aci_ P,o , Non-Dai
JLayers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Turkey Poults
Other
Wean to Feeder
Z,od
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes [:]No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes VN
❑ NA ❑ NE
[] Yes ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of Inspection: i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o ❑ 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: l fi G4G
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2.�0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[;�/No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments reat, 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 ZNiob ❑ 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 Y - - ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If_.Es, 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):
l3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes jf]N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:)Yes [/No ❑ NA ❑ NE
acres determination? f
17. Does the facility lack adequate acreage for land application? [:)Yes EJ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes QXo` ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes To ❑ 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 EfNo ❑ 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 0 ZOD
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes , NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - *l jDateof 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 to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesF:IrNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes to
❑ Yes No
❑ Yes No
❑ Yes CJ/No
❑NA ❑1\E
❑NA ❑NE
❑NA ❑1F_
❑NA ❑N
❑Yes �CJI'' ❑NA
El Yes V ❑ NA
❑ Yes XNo ❑ NA
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ N
❑ N
❑ N
Phone: (90 I qb " 30QVv
Date: Z�
21412011

Type of Visit: is Co pliance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (Routine Q Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: (, t Arrival Time: Departure Time: © County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: DA11�D �1J O�t2:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C•u_rrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poul#ry Capacity Pop. Cattle
La er Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
9 OJAD SIM
I INon-Layer I Dairy Calf
Feeder to Finish
Farrow to Wean
Dairy Heifer
Design Current Cow
Farrow to Feeder
Farrow to Finish
1!7
a aci 11170p.Non-Da'
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [�No [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ o
[:]Yes o
[:]Yes No
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
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
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No
Structure I
Identifier:
Spillway?:
Designed Freeboard (in):
p1�
Observed Freeboard (in):
37
❑ NA ❑ NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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?
E Yes ZNo ❑ NA ❑ NE
❑ Yes [EI/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen
,tl threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes E(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2/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 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes WNO ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EJ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:�eNo
❑ NA
❑ NE
l & Is there a lack of properly operating waste application equipment?
❑ Yes
[;,No
`�
❑ NA
❑ NE
Required R_ ecords & Documents
Yes
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[;3
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
G 1V 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
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
VNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility umber: Date of Ins ection: (a
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes �(No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Eryes �zo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [yNo ❑ NA ❑ NE
❑ Yes [j"No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes []No
❑ Yes
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comm;en. ts-(refer to _question :#): Explain_ any YES answers andlor, any additional recommendationsror',any other=comments:
L1se,dwf facili. rai. ....
iri.)
01&TAT�*3
of-tj
C C, Wz.TH
NUJ
R-5,
ac . )
Y-C-C P
COPS
0�- bT CL-
C"CL't 4
ZCC_o a'Ds
Reviewer/Inspector Name: ,. V N3 F V-13
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ( -M6 _ T1
Date: 11
21412011

Type of Visit Co�apliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit;4AE1 Arrival Time: // ��� Departure Time: County: r Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ,7 Title:
Onsite Representative: l; Ea�E r ETi+1!" Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = . =, Longitude: 0 ° = = "
inncgien, Design C*urrent
e Capapation Wet Poultry Capacity Population
Design urrent
Cattle I.p.cgyAqo ula on
❑ Wean to Finish
❑ Layer I
❑ Dai Cow
CR Wean to Feeder
160
❑ Non -Layer I
I
❑ Daity Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Pullets
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars
ether
❑ Other
El Turkeys
❑ Turkey Poults
I❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ o
❑ Yes o
El NA
El NE
❑ Yes WNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 31 -- Date of Inspection
Waste Collection & Treatment
WNo
�. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,_/
LJ 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
�,�
L9 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
ONo
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [JNo ❑ 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 [Z'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EYNo ❑ 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
[3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
La"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
9No
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
[a No
❑ NA
❑ NE
Comments -{refer to question #}:, Explain any YES answers apd/or any,rec6mmendations or7any other comments"'y
Use 'd`rawiugg of.tacilityAo, better explain situations (use additional pages as necessary}
Reviewer/Inspector Name/ .e: ;(, - Phone: q D fi — 7 ��
Reviewer/Inspector Signature: Date: 37/4
Page 2 of 3 12128104 'Continued

Facility ]Number: — Date of Inspection
lieguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VC ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WIJF ❑ Ch 1,1' ❑ D ' ❑ M ❑ O h
sts ec resign aps t er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
7No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3 o
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑'Yes
o
❑ NA
[3 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2b
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
7N4o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L/ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[2(No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E�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
[�N
❑ 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
d� o
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Addrtional Comments and/or Drawings:
t
Page 3 of 3 12128104

`)
Type of Visit Q C mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3d 0 Arrival Time: arOO Departure Time: ® County: JV tz Region:
Farm Name:
Owner Name: —
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: Ga12&s Pcnkr
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 ' 0 " Longitude: = ° = ' a
Design
Current
Design Current Design Current
Swine
Capacity
Population
Wet Poultry C**specify Population Cattle C►►opacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
Wean to Feeder
L6o
❑Non -La er
❑Dai Calf
❑ Dairy Heifer
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Non -La ers Pullets ❑Beef Feeder
❑ Beef Brood Co
❑ Turkeys
POGilts
Boars
Other
❑ Turkey Poults
❑ Other
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E�No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
ElYesYNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

FAcility Number: 31 Date of Inspection sb 9
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes U No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structuur�relI I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: LA&card
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2No ❑ 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 environmentaltreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ef 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ZYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
dNo
❑ 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
[4/No
❑ NA
❑ NE
seMrawmgs bf facifity to nettet.explain situations (use addas nei
J S) ukAo VP 56-t
Reviewer/]nspector Name 1 1V I/ I Phone: _ 3K
Reviewerhnspector Signature: Date: 6 6
A- 7 _f 2 Continued

Facility Number: L— Date of Inspection 6 d
Ike wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA El 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 El Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El 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
� o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EdNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ENo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Z/No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ("No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ld 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
VNo ❑ 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 No Cl 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
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
EJ CoN❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

I I M. 8Y'1
Type of Visit Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ? a d Arrival Time: Departure Time: County: aA/Rlt� Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: GEC F_ EL-tlos Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 6 0 [ ❑ Longitude: = ° = i
Design urrent Design
Current
Design
Current
Swine
Capacity ulation Wet PoultrJ Capacity
150
❑ La er
'1� ❑ Non -Layer
Population Cattle
Capacity
Population
to Finish
❑ Dai Cow
Rean
ean to Feeder
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Turke s
❑ Beef Brood Co
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes UrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El NA
❑ NE
El Yes
VNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 6 �8
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L AGagi
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): b Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZfNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes El"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 thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? Cl Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? ❑ Yes WNo ❑ 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 C ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. El Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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? ❑ Y s ❑ No ❑ NA ❑ NE
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
JS
i c tx J
26.) ?04
ve S 64
61 C.
Wdo ElNA ❑ NE
No El NA El NE
Ld No ❑ NA ❑ NE
Reviewer/Inspector Name Phone: ( 4rD) '�ff C -T ff
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

r
Facility Number: — Date of Inspection 5
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes INo ❑ 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
Rio
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0No
❑ 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?
El Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
E No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
E Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1J No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L`J No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETONo
❑ 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
Elk�
�,
4o
❑ 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
El Yes
��
D 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
1 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E'h}O
❑ NA
❑ NE
iAddItinnal Comments andlorbirawir ` ' r rv► z �+' ;^
,ags., "
Page 3 of 3 12128104

Facility Number g�']
("ivision of Water Quality
0 Division of Soil and Water Conservation
O Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,,compliance
(�//Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 07 Arrival Time: 4 Departure Time: County: DUPLIL) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 6,E6P-6 C �'-')L-TVI Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = ` =" Longitude: a ° =' "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder 7,
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
E
�I
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑N ❑NA
El NE
El Yes
El Yes
IQ o ElNA
[INE
[IYes
L'J No ❑ NA
❑ NE
12128104 Continued

Facility Number:'] — Date of Inspection
'Waste Collection & Treatment t
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: "
Spillway?:
Designed Freeboard (in): 'L
Observed Freeboard (in): GO
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
L No ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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
E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
n 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 Drifi ❑ 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?
0Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
,[�-No
�Zo
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
LJ
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: i1u 73
Reviewer/Inspector Signature: Date: = G o

f
Facility Number: — Date of Inspection 8� o
Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ EJ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E I No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ON- o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BINo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[I Yes
❑ No
,❑,,
EIN"A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElE Yes
�Dlo
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
��
[J 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
El 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
❑'1 Two
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[;,4/o
❑ NA
❑ NE
Additional Comments and/or
12128104

Division of Water Quality
kacility. NumberM
�4 7 O Division of Soil and Water Conservation
._; _.... — -- g y
0 Other A enc
Type of Visit ercompliance
Inspection
Q Operation Review O Structure Evaluation
Q Technical Assistance
Reason for Visit
ekoutine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ll County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
D
Onsite Representative: �Ed/C�Cr6 T E S
Owner Email:
Phone:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 . = Longitude: = ° 0 d 0
Design Current Design Current. Design Current'`-"
Swine'... Capacity Population Wet Poultry . Capacity Popullation Cattle 'CapacityPopulatioO. �
❑ Wean to Finish
�C] Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
her
❑ Layer
El Non_
Layer
I� Dry Poultry--
❑ La ers
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
'Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E N
El NA
El NE
❑ Yes
�,V U
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — 94 Date of Inspection �J
Waste Collection & Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA (rarcl-tJ
Spillway?:
Designed Freeboard (in): gig
Observed Freeboard (in): '" .'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Cl"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? El Yes E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 990 ❑ 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 2/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) G)
13. Soil type(s) N �2�aC..i< TR-'?
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? [;Wes ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question ft 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):
rS,) fASt fNb a Quw F + Z 14AI 2040.X06r WATVL, Ff"V0 Y'A KAXj E41oQVr
1q R6a NEEbt PC- SW -A ct0 & , PLEASE A 00(L .S ' V falter Ut.rLrz.rA/&
F-6 dL- .sAXLL tj AT E ?i✓Li__
2E CA L Cs1 LA T60 WM L
AcrZ,E A &-E ►4X 11.- V. O d d f d 3 E
'A J>0 0-f-ssCP
Reviewer/Inspector Name f ,3-''4 U L-(, Phone: L 41() 9 - �8
Reviewer/Inspector Signature: Date: G 6
Page 2 of-3 I2128104 Continued

Facility Number: 3 -MI Date of Inspection 7 0
Ree uired Records & Documents
19. Did the facilityfail to have Certificate of Coverage & Permit readily available?
8 Y ❑Yes N ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Lr No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E5No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U N ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
@(NA
❑ NE
❑ Yes
[] No
2fNA
❑ NE
❑ Yes
LEI No
❑ NA
❑ NE
❑ Yes
❑ No
El"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?
Comments and/or Drawings:
❑ Yes Cl No ❑ NA ❑ NE
❑ Yes URI o ❑ NA ❑ NE
❑ Yes Ej>,a ❑ NA ❑ NE
❑ Yes -No ❑ NA ❑ NE
❑ Yes WN-
9ElNAElNE
ElYes ❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: (1 Arrival Time: ; 2' Departure Time: unty: � /� Region:
Farm Name: �� �� Owner Email:
Owner Name: i///iQ Gb Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: lit—O/�G'� ET�I Integrator:
Certified Operator: KllAJLC1�Y] - _ _ Qcy���J Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: ❑ o = I = « Longitude: = o ❑ 6 ❑ 1{
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er ;
F LEI. Non-Layet
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
EFDry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: 111,
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 VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes /No ❑ NA ❑ NE
❑ Yes tVNo ❑ NA '❑ NE
12128104 Continued

Facility Number: Date of inspection -a
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ 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?: ddk
Designed Freeboard (in): 27
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 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 ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 21 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 �0No ❑ 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 WindoV ❑ Evidence of Wind Drifl ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from (hose designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2�No
❑ NA
❑ NE
L�� Ufa os.✓�.
Reviewer/Inspector Name �S Phone: /e
ReviewerlInspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes /No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ RainfaIl ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NE
Other Issues
JVNA
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V.No
V.
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
PNo
[INA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
/No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;—Z""No
❑ NA
❑ NE
Additional, Comments and/or DraKings: t -�
C f/�6X 4AO4.u4X:5
12,128104

of Visit f6 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit JO Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit:
Facility Number
0 Permitted [3 Certified 0 Conditionally Certified 0 Registered
Farm Name: �&'e A4 ......
Owner Name:.._ .............».L!.1.�_��!�£.L». . ��G
Tune-
Not Operational O Below Threshold
Date Last Opera or Above Threshold.:
County: k(a6o ✓
Phone No:
Mailing Address:
Facility Contact: Title:. » . » _ » Phone No: _
Onsite Representative:�Q�t` » f�y�/S _ Integrator.
Certified Operator:. ___..,.». ... » » . _..» , » Operator Certification Number.
Location of Farm:
{Swine ❑ Poultry ❑ Cattle 0 Horse Latitude Longitude �• �� ��
Design
Ciin�ent = ` Dew Cnrreat
Ciirreat
SwineJr ci
Po ionPoaltry'
„_ ti =Pow .bn ..Cattle
alahon
- Wean to Feeder
Layer
Dairy
- Feeder to Finish
Non _Layer
Non -Dairy
=
Farrow to Wean
-
_
Fatmw to Feeder
Other
h
Farrow to Finish
CaFac><ty
Total DesignGilts
Boars:
::Total SSpvv
Nt� 41.00IIS
;
Disebames & Stream Iin acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
RfNo
❑ Yes
KNo
❑ Yes
;2rm
Structure 6
Identifier:
Freeboard (inches):
12112103
Continued

Facility. Number: — Date of Inspection D v
5. Are there any immediate threats to the integrity of any of the structures observed? Cie/ trees, severe erosion,
❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes 0 No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/unprovement?
❑ Yes RrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ;ZfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes �No
elevation markings?
Waste Anniication
10. Are there any buffers that need maintenance/improvement?
❑ Yes PNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑Yes No
❑ Excessive Ponding ❑ PAN ❑ ydraulic Ov load ❑ Frozen Ground ❑ Copper d/or Zinc
12. Crop typez.� L v
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan CAW)?
❑ Yes A No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes 7'No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes Jz No
16. Is there a lack of adequate waste application equipment?
❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 00 No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes WONo
19. Is there any evidence of wind drift during land application? {i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes�No
Air Quality representative immediately. /
�� �'�p3'=�`r��t�'��1�8�:�'3'k ❑ i+ield Copy ❑Final Notes
L�[cJ AR& �N �y�p EAR �'4 �` �EIGGS F&&rrg��_ j0,,-,7 19P 4A6A 1,1A)7Zt,
�iP�BL•�n �oGc1� .
Y
r /' � �d"
�� �� �� 5 7� O��
Reviewer/Inspector Name
ReviewerAnspector Signature:
I2/I2103 ConUnued

Facility Number; _ Date of Inspection ZO
REguired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes A No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ONO
23. Does record keeping need improvement? U yes, check the appropriate box below. ❑ Yes FfNo
❑ 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 )2fNo
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes PNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes XNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,,&No
N''PDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes XNo
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
22/I2M3

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complain# O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number Date of Visit: Time: to D
O Not Operational O Below Threshold
Permitted Q Certified 13 Conditionally Certified E3 Registered Date Last Opeoad or Above Thresbold•
Farm Name: ..1 �_—�� —_ .1.!'2 S,h.�1 Counth_. ..............•............
�
Owner Name:..------. -•- ,�, 1 1. .... 4—AL,.......................... Phone No:
r.................
Mailing Address: ............... .............
Facility Contact: .................... ................................ Title:
.......................................�...... ......... ..... Phone No:.................................. _ ..........
Onsite Representative: &efr- _......................... .............................. Integrator-... ` iQ........._......................... _
.
Certified Operator.
Location of Farm:
..... ....... ............... ................. ............ Operator Certification Number: ..»..................... ............ ...
swine ❑ Poultry ❑ Cattle ❑ horse Latitude 6 ` " Longitude • 4
Subsurface Drains Present
No Liouid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. 1£discharge is'observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galfmin?
d.- Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier: .. --- -.._ . _... _.------
Freeboard (inches): ......... .. ..........................................................
❑ Yes ' ❑ No
❑ Yes RfNo
❑ Yes XNo
❑ Yes No
Structure

Facility Number.
Date of Inspection ([ c JQZ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(H 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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovement?
11. Is there evidence of over application? ❑ Excessive 1
12. Crop type
[J Yes No
❑ Yes YINo
❑ Yes � No
10 Yes �No
❑ Yes ZfNo
Cl Yes No
❑ PAN ❑ Hydraulic Overload ❑ Yes X
No
n f„ . N
13. Do the receiving crops differ with those designated in the CertiffUAnimal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/laspector fail to discuss reviewlmspection with on -site representative?
24- Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes VNo
❑ Yes �No
❑ Yes V{ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes XNo
❑ Yes XNo
3] Yes No
❑ Yes YNo
.0 Yes XNo
No violations ordeficiencieswere noted during this visit. -You will receive no further correspondence about this visit.
S'
.w v
....- .. . ........ ...�i .. . ..,... .. .. ...,.....-....... v '
Field Final Notes
:-:.-.:k:::.: ......... . s-...: ......-........ :`.::r: Wit:
X �}CAFp ®M 7Pr
RevrewerInsPector Name
Reviewer/Inspector Signature: Date: .

0SIO310I
Facility Number. — Date of Inspection
Continued
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e_ broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes 7Np
Yes
Cl Yes
❑ Yes
0 Yes o
Yes No
❑ Yes ❑ No

Division of Water Quality
QDivision of Soil and Water Conservation
0 Other Agency
Type of Visit 'KCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit. 4 Tune: 3 _Q�Printed an: 7/21/2000
0 Not Operational 0 Below Threshold
[] Permitted [3r'�)t
ified 13 Conditionally Certified E3 Registered Date Last Operated lbove Threshold: ......... Farm Name: ............ /.....'. �-� :.......... County: ! ( L1............
;7,**... I ........................
Owner \lame:..
Facility Contact
Phone No: ........................
MailingAddress: ........................_............................. .......................
Integrator: �v�S,Ir?y�/
Onsite Representative: ..........................P...K��.......-................................. ....... ..,c�...........
Certified Operator Operator Certification Number:..........
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder ? �D ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JE1 Subsurface Drains Present IFI Lag,-nn Area ❑ Spray Field Area I
Holding Ponds / Solid Traps JE1 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 I7WQ)
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:.........1/3................ ........... I ......... I .............
. ................................... .......................... ....... ................................
Freeboard (inches):
5100
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes WNo
❑ Yes RNo
❑ Yes ) No
Structure 6
Continued on back

Ficility Number: 3 — '{ Bate of Inspection Printed on: 7/21/2000
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 J 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 I�INo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes jkrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes WNO
Waste Application
10. Are there any buffers that need maintenance/improvement`? ❑ Yes W No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑Yes [�(No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes gNo
14. a} Does the facility lack adequate acreage for land application? ❑ Yes P(No
b) Does the facility need a wettable acre determination? ❑ Yes fl;tNo
c) This facility is pended for a wettable acre determination? ❑ Yes [ZNo
15. Does the receiving crop need improvement'? ❑ Yes 5 j No
16. Is there a lack of adequate waste application equipment`? ❑ Yes Vlo
Reouired 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?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
[(No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[KNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
allo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
14 No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
IRNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
0: �Vc . iolaiidris:or dePicjend6 -vv-ere noted- ding 4his.visit.' - Y:otx will-Teeeive iid further
roriesponrzce. about. this :visit... . .. . . ..
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�r� �[�� ru�'L iQl/�� A/V LI— 1►'� 6, A +
1 4 /
ta5oov\_ I-e
ct-� HIA1/ Y 1 Ca.+�
Reviewer/Inspector Name
Reviewer/inspector Signature ate: 5/00
4/U- CSC= ?s9j) r �zr

IFacility umber: Date of I►Lspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes j(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes &�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [!fNo
roads, building structure, and/or public property)
24. 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 DNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes I�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
Additional Comments and/or Drawings:.
'&1
J

Facility Number Date of Inspection
Time of Inspection F__1T-_0U_j 24 hr. (hh:mm)
s Permitted 13 Certified ■ Conditionally Certified p Registered 0 of Operationa Date Last Operated:
Farm Name: Coyote.Nurseries.................. ............. County: Duplin VVIRO
...........................................................
Owner Name:... ................................................ MaxyxeII.Fao.ds.JWc .............................. Phone No: 9,19=17&3.1311..........................................................
Facility Contact: ................... ..... ...Title: ....... Phone No:
......... .... ......................................................................................................................
MailingAddress: F..O .fax.IA.009..................................................................................... Gojdab.arjx,.NC ..................................................... 27.532 ..............
Onsite Representative: A 3.1jutua................................................................................... Integrator: Goldsbar a.Hog.Farms.......................................
Certified Operator: ].iytakvood..M........................ Hallaud ............................................ Operator Certification Number: 165.15..............................
Location of Farm:
Latitude ®* I U8 Longitude
Design - urrent
Swine Capacity <Population
®'Wean to Feeder
❑ Feeder to uus
p Farrow to can
-
❑ harrow to Fee er
❑ Farrow to Finish
❑ Gilts
❑ Boars
esign. - •Current Design -Current. .
,Poultry Capacity Population Cattle Capacity- Population
❑ Layer 10 Dairy
- ❑ Non -Layer I JE3 on- airy
❑ Other
Total Design Capacity 7,200
Total',SSLW 216,000
-Number of Lagoons O u sur ace rams resent ❑ agoon rea ❑ pray ie rea
m, ,s
Holdsng'Ponds/Sohd;Traps; p o �qui aste anagement yysem
'"
Dischar= -& ream Impacts
1. Is any discharge observed from any part of the operation? Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field Cl Other
a. If discharge is observed, was the conveyance man-made? Cl Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) © Yes N 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 N 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 Coll_egtign _& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway p Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): 36.... ............... ...........................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, 0 Yes N No
seepage, etc.)
3/23/99 Continued on back
Printed on 11123/99

Printed on 1112,'fAg
.f
act y um er: 31-847 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? p 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
S. 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? p Yes H No
I I- Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ® No
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? Cl Yes []No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
1S. Does the facility tail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
CT : N•o:vititations:or-deficieilcies'were' i-6ted •during. this :visit.: Yoir w' H1' •receive~ tia further• • .
corespv>ideilce: about this: visit:. :.......:..:::::::..::............ .
❑ Yes H No
❑ Yes N No
p Yes ® No
❑ Yes ® No
❑ Yes Ig No
❑ Yes ® No
❑ Yes Ig No
❑ Yes ® No
❑ Yes ® No
❑ Yes H No
❑ Yes ® No
Comments (refer to question fl — Exp1ain any YES answers anci/or any. reeornmendations or any other: comments. -
-
i se di ings of facility'to better tsplain'situations (use additional pages as necessary) " __
3
.
M19
z
z.
•.
j
°{"
- _
Fes'?
s:
#t
.�" .a 7 t- a ,• •
a
Pj
Reviewer/Inspector NameVlargaret.QbKet fe ,
Reviewer/Inspector Signature:
Date:

Printed on 11/23/99
Facility Num er: 31-847 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ® No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? []Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? []Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) © Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes N No
iN
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Printed on 11123199

;© Division of Soil and Water Conservation Operahon,Review W }
3 f
s.
El Division of Soif'and Water Conservation. - Coinphance Inspection7.
Division.of Water Quality -Compliance Inspection
0Other Agency=-' Operation Review
O,Routine O Complaint O Follow-up of DWQ inspection O Follow-up of Dswc review O Other
Facilitv Number late of Inspection
Tinie of inspection 66 24 hr. (hh:mm)
Permitted [3 Certified © Conditionally Certified [3 Registered 113 Not Operational Date Last Operated:
1,
Farin N<►mc: ...........tc-`!�f....................................................... .... County: ...
......_.......3A.................................. .......................
Owner Name:..... `¢��� � r Phone No:
`............�rF............................................................._..................................._................................
Facility Contact: Title: Phone No:
MailingAddress:................................................................................................................................................................
A
Onsite Representative: Integrator: ,,,,,,,,,,
-.............................................
Certified Operator: .......A7....... ... .......... Operator Certification Number:....
....
..............
Location of Farm:
Latitude C' �' �' Longitude
Design Current
Swine Capacity Population
%Wean to Feeder
0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes VNo
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 Waters ❑ Waters of the State
c. if dischai-C is observed. what is the estimated Ilow in galhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
1 Were there any 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?
Structure I Structure 2 Structurc- 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ................ a ......:. ......................................................................................................................................................
116199
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
KNo
❑ Yes
�(No
❑ Yes
kNo
Structure 6
Continued on
back

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [XNo
(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 pact of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes DdNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes {Vf No
11. Is there evidence of over application'? ❑ Ponding [Nitrogen Yes ❑ No
12. Crop type � ...................................................... - ....................... I ....... I .... ................................................................................................ .............................................................................................................................................................................
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9No
14.
Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
NNo
15.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
gNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
0No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(icl WUP, checklists, design, maps, etc.)
❑ Yes
KNo
19.
Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
0 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[YNo
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
[�*qo
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 reviewlinspection with on -site representative?
❑ Yes
�No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[RNo
N0,violations .or. deficiencies :were noted during -this-visii.. Y•au will .receive nor further ::: :
1P,
eorrespgiideh4} e:About:thisVisit.:•: :::•:•:•:•:•:.:. ,•:.. ..:•::•.•.•:•:•.•:•:•:•:•:•:•:•:•:•.
'Comments (refee. to question #): Explain any YES answers and/or any.recommendations or any other comments
Use dra win s of facility to better explain situations. use additional a ` -g ty _ ... p .. { pages as necessary)
l `—L l 1\�s lG-� C'� 9 r�l�. ['
l %%�vV/h'r
Reviewer/Inspector Name :.A­%1\
AL
Reviewer/Inspector Signature: Date: 2L3al 11/6/99

Revised January 22. 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number Operation "1~ Operation is flagged for a wettable
Farm Name: �� acre determination due to failure of
On -Site Representative: =..S Part 11 eligibility items) Fl F2 F3 F4
Inspector/Reviewer's Name:�''�
Date of site visit:_r3- qn
Date of most recent WUP: l0 134 96
V Operation not required to secure WA
determination at this time based on
exemption E1 (0 E3 E4
Annisal farm PAN deficit: 4�'35�FV pounds
Irrigation System(s) - circle #: 1Qhard-hose traveler, 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
V E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is -complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as veriied in Part 111. (NOTE: 75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part If. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational table in Part 111).
PART 11. 75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required because operation fails one of the eligibility
requirements listed below:
F1 Lack of acreage which resulted in over application of wastewater (PAN) on spray
field(s) according to farm's last two years of irrigation records.
F2 Unclear, illegible, or lack of information/map.
F3 Obvious field limitations (numerous ditches; failure to deduct required
buffer/setback acreage; or 25% of total acreage identified in CAWMP includes
small, irregularly shaped fields - fields less than 5 acres for travelers or less than
2 acres for stationary sprinklers).
W F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III.

Rvviscd 3anuar3, 2?, ? 9,
Facility Number
Part Ili. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER"2
TYPE OF
IRRIGATION
SYSTEM
TOTAL.
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
s�
li
11
I
I
I
FIELD NUMBER'
- hydrant_ Dull. zone. or Doint numbers may be used in place of field numbers denendino on CAWMP
and type of irrigation system. If pulls, etc. cross more than one field, inspectorlreviewer wilt have to combine fields to
calculate 75% field by field determination for exemption if possible; otherwise operation will be subject to WA
determination.
FIELD NUMBER' - must be clearly delineated on map.
COMMENTS' - back-up fields with CAWMP acreage exceeding 75% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous two years' (1997 & 1998) of irrigation records, cannot serve as the
sole basis for requiring a WA Determination. Back-up fields must be noted in the comment section and must be accessible
by irrigation system.

❑ Division of Soil and Water Conservation ❑ Other Agency
El Division of Water Quality
I%,Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection G O 24 hr. (hh:mm)
© Registered 0 Certified 0 Applied for Permit OPermitted 113 Not O erational Date Last Operated: -
Farm Name:.... a�� 1- '- 5e . County:...... .....V ...................................... .......................
Owner Name: �( E CST ..
I Y \Cl,a ............................ .......s.............................................................. Phone No:�`� r v 3
......................................................................
Facility Contact: .,L7Q � ,- P-...-----....- Title Phone No: .
---..... . (--................................................................
Mailing Address: ..�..0"' l �� a'� .....................................................�..........�.. ..... ..3.a.................. ...........
Onsite Representative: ...' 1{'.^s ............................................... Integrator:... <;!\ �x+1-c
..........................................................
Certified Operator;................................................................ .... Operator Certification Number,....................
I, t'on 9f Farm:
.....!^'i......�.44�..............`�ira...l�.... ...... ...... ... .........1.. ............................... G a
.............
....r'i..5.....�5..3�`7........................................................................................................... .
Latitude a 4 46 Longitude 0 4 6&
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes PfNo
2. Is any discharge observed from any part of the operation? ❑ Yes 19 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 Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
M No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[24No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
E4 No
maintenance/improvement?
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
CqNo
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes KNo
Structures (Laeoons,Holdine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) Iess than adequate? ❑ Yes �fNo
G
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A-
................................... --------------------------------------------------------------------------------------------------------•-................................... ...................................
Freeboard(ft): .. ��................................-.......................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes No
11. 1s erosion, or any other threats to the integrity of any of the structures observed? Yes ❑ No
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
Ca Yes ❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes Ef No
Waste Application
14. Is there physical evidence of over application? ❑ Yes MNo
(If in excess of WMP, or runoff entering waters of the Stag, notify DWQ)
15. Crop...-`2�....a-................................
n... 1...............1............
........-....................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes K No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
C9 No
18.
Does the receiving crop need improvement?
❑ Yes
CINo
19.
Is there a lack of available waste application equipment?
❑ Yes
1`4 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
®,No
21.
Did Reviewerlinspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
jgNo
22.
Does record keeping need improvement?
❑ Yes
IX 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
tA No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EJ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
EO No
0• No:violitioinssor' deficiencies:were-noted-during this:visit.- You:will receive -no ftirtlier
:. • correspondence about; this: visit::.. ; : , _ ::: _ . . . ; : : , ::: � : _ ::: - : _ . . : ; :: ; :::
7/25197
Reviewer inspector Namer,1 _ a
Reviewer/Inspector Signature: Date: aI

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Govemor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
October 17, 1997
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Maxwell Foods Inc
P_O. Box 10009
Goldsboro, NC 27532
macc_
7
� EE F1
Subject: Coyote Nurseries
COC No. AWS310847
Duplin County
Dear Maxwell Foods Inc:
The subject facility was issued a Certificate of Coverage (COC) on 5/19/97 authorizing the
operation of the animal waste collection, treatment, storage, and land 'application system in accordance
with General Permit No. AWGI00000. On Aug. 27, 1997 Governor Hunt signed into law the Clean
Water Responsibility Act. The Clean Water Responsibility Act included several changes to the Swine
Farm Siting Act (Siting Act) including the requirement that all set back distances be met for. any swine
lagoon or swine house for which construction commences on or after the effective date _of the Clean Water
Responsibility Act (Aug. 27, 1997). Before the Siting Act was amended, it required the set back- distances
be met at the time the swine house or lagoon was sited. The change in siting requirements may. apply to
your farm since construction may not have commenced by the effective date of the Clean Water,
Responsibility Act.
Your farm was permitted prior to the effective date of the Clean Water Responsibility Act;
therefore, you meet one of the exceptions to the moratorium. However, the farm must be re-evaluated
and, if necessary, re -designed to meet the new requirements of the Siting Act to remain covered under the
General Permit. Within 15 days of the date of this letter, you are requested to submit, notification to the
Division of Water Quality whether the farm was under construction on or before Aug. 27, 1997.
If the farm was not under construction on or before Aug. 27, 1997, then a revised Certified Animal
Waste Management Plan must be submitted to reflect the new siting requirements. Construction not in
compliance with the Siting Act is a violation of State Statutes and the General Permit.
If you have any questions or comments concerning this matter, please contact me at (919) 733-
5083 extension 540.
Sincerel
Kim H. o Fson, P.E., Supervisor
Non -discharge Permitting Unit
cc: Wilmington Regional Office, Water Quality Section
Permit File
F.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
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