670003_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

Date of Visit: 1 rj Arrival Time: Departure Time: ❑ County: n �1�w Region: �
Farm Name: , ' I i Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �'}�� ,, f Title:
1� f Onsite Representative: 6
Certified Operator: G'T
Back-up Operator:
Location of Farm:
Latitude:
Phone: -
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
"IHINon-L]ayer
I
Dairy Calf
Feeder to Finish
DesI
1_tr, Ca aci P,o ,
Layers...
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Othe
Other
Turke s
ITurkey Poults
10ther
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?
❑ Yes JNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
_]Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes .0No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Ye�No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

F-/
Fecility Number: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9'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 ONo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes Z'lNo ❑ 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 A No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes L2"No ❑ NA ❑ NE
❑ Yes
j;J'No
❑ NA
❑ NE
❑ Yes
O�No
❑ NA
❑ NE
❑ Yes
Z f No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes PNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

>iacility Number: P Date of Inspection: Q' S
24. Did the facility fail to calibrate waste application equipment as required by the permit?
f
❑ Yes
No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0'<o ❑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
PNo ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ONA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes O/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 PNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes &No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
'(24
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [:2/No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
Comments,(refer t-o question #): Explain, any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better exnlaid situations ( use additional pages as necessary}:
-
Wym iY_''�,Oy �S�1M / � �- WaR
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone: -� q & 752 1
Date: IS
111
2141201

F
(Type of Visit: Q ZRoutine
pliance Inspection V 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: -�! 1 Y 1 Arrival Time: l Departure Time: County: Z)A �ttj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: QQA0.Qo lJ 14d rN.A izD
Certified Operator -
Back -up Operator:
Location of Farm:
Title:
Phone:
Integrator:
Certification Number: 3 ��
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design C*urrent
Wet Poultry C««opacity Pap.
Layer
Design C**urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er I
Mwsign Current
D , P�oult . C•_a aci. P,o ,
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
'Z
Dry Cow
Non-Dai
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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?
❑ Yes No ❑ NA ❑ NE
❑ Yes nNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen0 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 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 tNo ❑ 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 jn 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 ManurelSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
o
❑ NA
❑ NE
ElYest�lo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
14
❑ NA
❑ NE
❑ Yes
F:fNo
❑ NA
❑ NE
❑ 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 Inspecti;�Io
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [] YesWNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

F4ciliNumber: - Date of Inspection: (p
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesVNo
❑ NA ❑ NE
2S Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 20 ❑ 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 [[.] N ❑ NA ❑ NE
[—]Yes ZNo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes C No ❑ NA ❑ NE
❑ Yes 6No ❑ NA ❑ NE
❑ Yes E f 1. o ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
Comments (refer to question #I): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better exDlain situations (use additional napes as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
,JCApJ FAR,0 C
Phone. qfv C —
Date: 3 (p
14 015

(Type of Visit: U Corr�pHance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i Arrival Time: I (C)SS 1 Departure Time: /ZU S County: OA4—UW Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: &KAQ V:at� IIAKID
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: 3
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
32Z7 ZaCaD
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P. - I Ca a_ ei P,o ,
Layers
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke 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 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?
r�
[] Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ENo
❑ Yes EfNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: 01 IDate of Inspection: i I •24
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ^3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
�NoO
❑ 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
dNo
❑ 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
13No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:)Yes
Ej/No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ 'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Rio
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Ej,"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
En"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F::(No
❑ NA
❑ NE
Re uired_Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FdNo
❑ 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.
[3 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 I " Rainfall Inspections [Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
EA/No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�rNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No [:]NA ❑ NE
91"
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 EZ(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)
❑ Yes ❑d10
❑ Yes ❑,No
loo
❑NA ❑NE
❑ NA ❑ NE
[:]Yes [2fNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑. Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
[E]N.
❑ NA
❑ NE
�No
❑ NA
❑ NE
❑No
❑NA
❑NE
!\I.YIV WC.If L1�J�lll.LV1 i�auu.. • �-- r -- ---- ♦., a uvu�_ • •—/ ♦ j 4 r
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Type of Visit: Q Copfpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency p Other O Denied Access
Date of Visit: 1j 1 Arrival Time: }� Departure Time; O County: Or�ZLZJj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 19"Ij,*j 1- OWngb Integrator:
Certified Operator: Certification Number: 1 1 3 8 L
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current Design C►urrent
apacity Pop.
Capacity Pop. Wet Poultry C10
[Layer
Design
Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
LNon-La
er
EEJ
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Z
Design Current
lti, C*_a aCi Plo
Da' Heifer
Cow
Non-Dai
Beef Stocker
Gilts
ers
Beef Feeder
Boars
flLayers
Beef Brood Cow
er
Other
Poults
Discharizes 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)
i 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?
Page 1 of 3
[—]Yes ❑'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ Yes2-;-N-og
o ❑ NA ❑ NE
21412011 Continued

Facility Number: jDate of Inspection: I
Waste Collection & Treatment
4. Is Storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LiC_Ct5IJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3
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 D<o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 531§ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ET<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
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U3 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?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L 2 <o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]'go
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L]No
❑ NA
0 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. 0 Yes rjNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21417011 Continued

Facility Number: - Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
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 D/Nc ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ;'�fo ❑ 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)
❑ Yes E3 o [_]NA ❑ NE
❑ Yes J2<0 ❑ NA ❑ NE
❑ Yes
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
To ❑ NA ❑ NE
T� o ❑NA ONE
No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facilitv to better exalain situations (use additional naves as necessarv).
Reviewer/Inspector Name:
ReviewerAnspector Signature:
Page 3 of 3
Phone02
6 _7Q6
Date: 91 1 i-R 1 14
2 4/l0 1

Type of Visit: UTRoutine
Hance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: 3 u Arrival Time: Departure Time: /p /$ County: ON.SCA W Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative:
e LA N o0 W o W A Rb _ _ _
Integrator:
Certified Operator:
Certification Number:
r7 3
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
HNon-Layer
Design Current
Dr P,oultr� C►_a aci. Pao
Layers
Non -Layers
Design Current
CRd Q= apacity Pop.
DairyCow
DairyCalf
Wean to Feeder
Feeder to Finish
a
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Wean '
Farrow to Feeder
Farrow to Finish
Gilts
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? ❑ Yes EfNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No [] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes �No
❑ Yes F3"No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Faciti Number: Q -3 Date of Ins ection: 2' j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4(rwr-)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ll 0
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?
❑ Yes No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑`No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes D/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance 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 ['No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ffNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [2!f/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes dNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [ "No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [y No ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []'14o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: IDate of Inspection: 1 �S' 1-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3'Nio ❑ 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 [3"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Fj 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 0 No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [!!fNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes C]-No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 64 ❑ NA ❑ NE
Comments (refer to question fl: 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):
f o)�gb
Reviewer/lnspectorName: J61-11� Q1�SCLI� Phone: kgl
Reviewer/Inspector Signature: q-110, Jk,16 Date: 3 /-H /13
Page 3 of 3 2/4/2011

Type of Visit: d Comroutine
ante Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint O Follow-up O Referral 0 Emergency Q Other O Denied Access
Date of Visit: 31 Arrival Time: / Departure Time: / Z /� County: 1 / Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative: 19-PJ'Dbtil He,%4„gFAA-t% Integrator:
Certified Operator: Certification Number: i� 3gZ
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design C*urgent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
2 Z$b�
Layer
La er
Da' Cow
DaCalf
Da' Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D r PlouIt ,
Ca aci_
PO
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes E(No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No❑ NA ❑ NE
❑ Yes iLJ '`' ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili' Number: b -I Date of -inspection: 1
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3
Identifier: ;jAand
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5
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?
EZI/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes 1jyNo ❑ NA ❑ NE
[]Yes No [DNA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envi 6nmental 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 a<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 040 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes []"'No No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 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?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
[—]Yes do
❑ Yes F3/No
❑ Yes LJ N
El Yes Ld 0
❑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 WNo
' ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE

Facili q Number: - Date of Ins ection: 1 3 i i
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 �To ❑ 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
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
LzNo
❑ 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
ZNo
❑ 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
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
. ...,...,...ter.,.,.. .. N-4-11ry 1'1v-A.0 to e
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
❑ NA ❑ NE
I__IZo
❑ NA ❑ NE
❑ NA ❑ NE
Date: 1 '31 A t/
21412011

•Division of Water Quality =`
FaciittyvNumber 3 p �O.Division of'Soft arid;Water Conservation '
gert��y
x
= - Other,A;
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: -t ll Arrival Time: Departure Time: County: OX)SL O0 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
��))
Onsite Representative: E'R-PW boo) l�QL' fttt>
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o Longitude: = ° = ,
Design Current A
vine � r Capacity„ P.opulat�on Wet Poultry wC;
] Wean to Finish ;PEI
La er
Wean to Feeder ' Non -Layer
] Feeder to Finish 32
] Farrow to Wean
] Farrow to Feeder
] Farrow to Finish ❑ Layers
] Gilts [] Non -Layers
ti r ❑ Pullets
er - LE]Outhir
e Points
Other
Current
ty Population
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? .
Calf
Dry Cow
Non -Dairy+,
Beef Stocker
Beef Feeder
Beef Brood C
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[Z'No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection f7
r
Waste Collection & Treatment
14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LACo6iJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E(No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [2(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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 types) ,.,/
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ld No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
[ryes
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑No ❑NA El NE
[J"'No ❑ NA ❑ NE
El No ❑ NA ❑ NE
[,� No' ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answersandlor any -recommendations or any other comments :w
Use drawings of facility to better explain situations. (use additional pages as necessary)
l5,) F-6LC6 fJC-.E.D L T-ME
Reviewer/Ins ector Name Phone: �� —.�
P N.� P:
Reviewer/Inspector Signature: Date: 11
Page 2 of 3 � 12128104 Continued

facility Number: (�`� — 3 Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo
No ElNA ❑ 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 El Checklists El Design El Maps [3 Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
1�40
❑ 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
;� No
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E //o
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Ifo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[,_JNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes LINNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El[ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
4o
[INA
[INE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ !Denied Access
Date of Visit: 1 21 Z 110
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: 1 1100 Departure Time: County:
Owner Email:
Facility Contact: Title:
Onsite Representative: g i�ANOQN �o�
Certified Operator:
Back-up Operator:
Phone:
OPSU W
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: [__1 o = I = 1
1 Longitude: = o = 4 = {f
Design Current
Swine Capacity Population
Wet Poultry
Design
Capacity
Current
Population
Cattle
Design Current
Capacity Population
ElWean to Finish
❑ La er
❑ Dai Cow
Wean to FeederI[]-Non-Layer
El Dairy Calf
El Dairy Heifer
[ID Cow
ElNon-Dairy
Feeder to Finish
❑ Farrow to Wean
2
�j�
Dry Poultry
❑ La ers
an -a ers
❑Pullets
❑ Turkeys
ElTurke Pouets
❑ Other
❑ Farrow to Feeder
El Farrow to Finish
El Beef Stocker
ElBeef Feeder
El Beef Brood Co
dumber of Structures:
Gilts
PE]Boars
Other
❑ Other
Discharges & Stream ImRacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
6/No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: —
Date of inspection i-
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
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: (��N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
UNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental t reat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
YNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
U No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�f
L✓J No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
U(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
l2. Crop type(s)
l3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ldNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6/No
❑ NA
❑ NE
Comments (refer to question .#); Explain any YES answers and/or any, recommendations orkAny�g©ther5comments d
Use drawings of facili to. better ex lain situations: use additional a es as necessa
V1 )
I
Reviewer/Inspector Name � : Phone: q10
Reviewer/Inspector Signature: n - — Date:
12128104 Continued

Facility Number: 0—S Date of Inspection
Required Records & Documents
/
l9.
Did the facility fail to have Certificate of Coverage & Permit readily available?
El Yes
o
❑ NA
[I NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
YNo
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2/No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspection�No
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
- 23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
dyes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
G(No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
f
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,_
LJ 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
[�fNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
,�,/
[2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments,and/or.Dr`.awin
T
12128104

—. Z-
Type of Visit P3 coo ptiance 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: b Arrival Time: Departure Time: County: ILisf Olti% Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: IJ 146WAe In#egrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 =] ' = Longitude: [� ° =' 0
Design C►urrent
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Cap acity yPopulation
Wean to Finish
❑ La er
❑ Dairy Cow
❑ DairyCalf
FEI Wean to Feeder
❑ Non -Layer
Feeder to Finish 52-711 1900❑
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
❑ Farrow to Feeder
El Farrow to Finish
Gilts
Non -Layers
❑on -La ers
ElBeef Feeder
POBoars
❑ Pullets
❑ Turkeys
❑ Beef Brood Co
Other
❑ Turkey Pouets
❑ 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 dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑yes ❑NA El NE
❑ Yes ❑ NA ❑ NE
❑ Yes FJ No ❑ NA ❑ NE
Page l of 3 12128104 Continued

it acility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier: LA C7000
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes JNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I_(J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .YJ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes E(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 ENo ❑ NA ❑ NE
❑ Yes �YNo ❑ NA ❑ NE
XCon ments,(r fer d,quesho .# E plain ny YES as " and/or any recor_rtmendation_s or any other comments.
Use drawings dO Ciility�MlU tter eap�l�a�n 'situaho s (use add[t af,pages as necessary,}:
�w
Reviewer/Inspector Name �dj�]Af )Q A �-t-- Phone:
Reviewer/Inspector Signature: Date: a
Page 2 of 3 ` 12128104 Continued

Facility Number: — Date of Inspection r l
11
required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather Code
0
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
[2(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,1 o
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
YJ o
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
LI No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ENo
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ 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
ZNo
❑ 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
IQ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
C:�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additiional Commemts and/or
i
Page 3 of 3 12128104

I
Type of Visit ,C mpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit tJ Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (j O $ Arrival Time: Departure Time: County: ONSt.JIJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: +3Kxdoo1) 4 6'^'A (kD Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = d Longitude: ❑ ° = ' = "
Design
Current
Design Current Design C►urrent
Swine Capacity
Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
® Feeder to Finish 7,11
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Pullets El Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ Turke s
Other
❑Turke Poults
❑OtherI Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 1 1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
❑No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes[iNo
❑ NA
❑ NE
❑ Yes
L No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

FStility Number: '� — 3 Date of Inspection
te Collection & Treatment
As
storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LA &iMd
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
6o
❑ 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 environmentalt7eat, notify DWQ
El7. Do any of the structures need maintenance or improvement? Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ��
9. Does any part of the waste management system other than the waste structures require El Yes CI No El NA ❑ NE
maintenance or improvement?
Waste AnDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ell o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 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
Ko
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L `NNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
LK No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Rl"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
/["No
❑ NA
❑ NE
Gomments(r�efert© question,#) Egp any >Y;ES�answers and/or any recommendations or any other comments.
Use drawmgs?o%f,,,aciL�ty to better�expla�tn�s>,tuattons ,,(use�addthona! pages�as�necessary;}:. -
Reviewer/Inspector Name E Phone: 910779 — 7s F7
Reviewer/Inspector Signature: Date: & s
11 V L Vf J ­v ........r..ecu

Facility Number: V7 Date of Inspection
Rtjuired
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C (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
dT,
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ 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
EJ No
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
QNoo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
� o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes F.,Ko ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E3<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?
El Yes
,
No NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

.'r
Facility Number
(� Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
16Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1 130 Departure Time: County: ONJUO ,) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 812AQr]YAl PooARD I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c 0 t Longitude: =°=& Q
Design Carrenf Design Current' urrent"
�5wtae Ca aci Po ulation Wet Poul Ca aci Po ulation Cattle.
P t3` P �? p t3 p > .Capacity Popnlabon
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish
'3 X) 1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
w ❑ Other
�' ❑ La er
❑ Non -Layer
Dry. Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ 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
"Nusaber 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 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El Yes; WW'0'
El NA
[I NE
El Yes
❑ NA
❑ NE
12128104 Continued

FacilityNumber: (�� — 3 Date of Inspection t 30
W�`te Collection & Treatment 1
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R 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: (aA ii'qpr-�
Spillway?:
Designed Freeboard (in): 20
Observed Freeboard (in): 11-1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
eNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ElE Yes
�f
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
[3'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
L 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 Application
W. 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
PrNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[(No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E5 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ETNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use: additional pages as necessary)::-
Reviewer/Inspector Name fARNX__L`- I PhonAJ?10)'79(- -73 17_
Reviewerllnspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
R
Renuired Records & Documents Er
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LI No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U/ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L7 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2 o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B'1\lo
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EJ'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IJ 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
IJ 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
ENo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
CJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number ? 3
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (�C
,ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit ((/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t b(s Arrival Time: /
Lc? b Departure Time: County: dA)1 dk_J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: // Title: Phone No:
Onsite Representative: .�r �JDe�li 11041A&D integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: o [= d 0 Longitude: = ° u
Design Current Design Current Design "Cui
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity. Popu
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 13"V71 I l000
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Pouets
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Ca
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 O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 2(N❑ NA ❑ NE
❑ Yes LrJ No ❑ NA ❑ NE
12128104 Continued

Facility Number: (� —
Date of Inspection 10 to
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA 6o,)L�
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): L6
Observed Freeboard (in): -90
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L6No ❑ NA ❑ NE
(ie/large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ffNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7No
o El NA El NE
8. Do any of the stuctures 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 dNo ❑ 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 Z 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) acm O
13. Soil type(s) /4U_r Ay, X(,L..4_:
14, Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2(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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
�Zo [INA ElNE
o ❑ 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):
FL,(4 -r z)oN C .
).Jc.&n N&w WUP
Wke-_0 Som.p SET 0oNG.
Reviewer/InspectorName I `-rU L Phone: C1 6 — -7 _Vo,�
Reviewer/Inspector Signature: Date: p '0
l "A;c r. of v a. ..... ..r "

Facitity Number: (y') — Date of Inspection [abh
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other �,/
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes LJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ 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
[Z No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
!�J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LI No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ 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
C (No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[' No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
�
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
UNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 121128104

3
Type of Visit (2rCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit l J Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 161 ct4S` Arrival Time: j� 6`8 Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
�(LOnsite Representative: &NWt_) Ao LJ fig—=D,
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 Longitude: = ° = ,
Swin<Capacity
❑
1'4ems_ T : R., �� �- moo- .�• -;
Design Current Destgn Current
PupulattonvWetAPoult.111ry;Capactty Poptilatton
Wean to Finish -]Layer ' -
n .... .
r Destgn Current
r
Cattle Capacity Population
❑ Dai Cow
❑ Wean to Feeder JE1 Non-Layet ❑ Dairy Calf
® Feeder to Finish i ❑ DairyHeifer
,�
❑ Farrow to Wean "r Y t
I?ry �:�� � g= � ' � � " � ' ❑ Dry Cow
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
❑ Gilts ❑ Non -Layers
El Beef Feeder
❑Pullets
❑ Boars ❑ Beef Brood Cowl
i:'.� ❑ Turkeys P °
Other: ❑ Turkey PoultsW-010 MAI
❑ Other • ❑Other Number-`ofjStructurta ;��_
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 2J No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ElNA
❑ NE
❑ Yes
ElYes
E ❑ NA
❑ NE
El Yes
7No❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection S a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in): ZQ
Observed Freeboard (in): 2,3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �
6. Are there structures on -site which are not properly addressed and/or managed ElYes allo ❑ 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 environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E' No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O 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 0'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o El NA ElNE
maintenance/improvement?71
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 13eaZ.m ooA (mot-+ 1 366
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
Cd ❑ NA
VX
ElNA
❑ NA
�N El NA
No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
_ ,.1 --
Commenuestion #) E�ilam any YES answers and/or any recommendations or any other comments.
190=4tsu9smofi4fait,�'Cilli��'�Itytnybetter explain situations. (use additioa_. �"
aj.) p)ppL X-A_r_,;�o OF wFiS`C(_
f y 30 f`✓kT►S WASTC 1ANA--?5ZS A- OGT 0106-Y rv►�.ssi+JC,i
cA ,Vol. ANC r=rStJ, OFQATE C_RoF gXE_LD, kCEP C.aP� o�' ANM"Z.
SL U 0 CaE , A 01) CA1^01tii 1�EC oR-b s
Reviewer/InspectorNamed 4-N►=�:.�Adti-mot-= [.v �y Phone• 9►4 3�75 —107x ,Zt�
Reviewer/Inspector Signature: Date: S 9 b 5
1 12128104 Continued

ility Number: 1 — 3 Date of Inspection FRc3 q oY
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o El NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
dWaste Application ❑ Weekly Freeboard dWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ffAnnuat Certification
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain InspectionZOE]
Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ 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?
Other Issues
❑ Yes Ld o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes N ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes iQ o ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes o ❑ NA NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 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 o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:.:
12128104
12128104

i' I
Facility Number
Elate of Visit: i Z 0 Time: 1
Not O erational 0 Below Threshold
J3 Permitted 0 Certified 0 Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: HowA2fl FAKm1 s Fz&=sa County: [7mfsL&uJ - tj; K4
Owner Name: m AQXad Phone No: 121b — 3 2y — 3 552
Mailing Address:
Facility Contact: '' ll Title: Phone No: _ I
Onsite Representative: &?AADOtS Ha1n6y'D Integrator: MOZPAY 9
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` ° 66 Longitude ' ' Du
Design
Current
Design Current Design Current
$wine Ca acs
P,o ulation Pioultry
Ga acity L',o ulation Cattle Ca aci P.o Matson
❑ Wean to Feeder
❑ Layer
❑ Non -Layer
❑ Dairy
® Feeder to Finish
3 27
❑ Non -Dairy
❑ Farrow to Wean
❑ Other
❑ Farrow to Feeder
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / solid Traps
❑ No
Liquid Waste Management S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatme_nt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: r�
Freeboard (inches):
05103101
❑ Yes )dNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes Pro
❑ Yes',ZNo
Structure 5
Continued

A,
Facility Number. — Date of Inspect -ton
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Haste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12_ Crop type
13_ Do the receiving crops differ with those designated in'j Certi
34. 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?
Oe/ 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 Dv;-Q of emergency situations as required by General Permit?
(ier discharge. freeboard problems. over application)
23. Did Reviewer/Inspector fail to discuss reviewAnspection 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 ONNo
❑ Yes ,LEI No
❑ Yes L N'o
El,�I Yes No
❑ Yes No
❑ Yes 2"No
❑ Yes ONO
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes O'No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes ONO
o
❑ Yes �No
❑ Yes XNo
❑ Yes YNO
❑ Yes ❑ No
❑ Yes ONo
❑ Yes XINO
❑ Yes �No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
:,-•-�:-.,,cr, ... ... - --fir+ .sr Wiz,,.. -'-�:_'"r�..:w..�:
Caiiimeiits'(refer to qii st n 9 - . Eatplai-any�.YES snsrreis apdfar. say recon�menaat<ons flr atry ti er aimm ts:- t - 7
w ry = -
Use drawin of facili to better ezpilsiii situations. (use additional pages as a a L
h .. ��') M .:] Field Copy ❑ Final Notes
"'ti..+.re+s.wa+...^m���r.'��^w3.:�^.^u"r^.'_ 44�_�i'"R'YA
.-+"-i.�aw-.. w�++ - N�..�w.�:.w.iC 1'..a:,.•��.w L-. .. S.ei✓........Re+iY�2T'-?,-Y'. .r.�.]+Xi �t4zi- ..'f �v .��a+.o.r-
/(� � � NSPF_CY�ar� F�OQ'r OR- Az✓zGz7=f ''��v� �,�
//71 y 15;64 ��ep
OV
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28_ is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure. and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? O.e_ broken fan belts. missing or
or broken fan biade(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? .
Comments and/or
22, ,gB SuR� � �2f� Gf5 Q� f>ZGN'
❑ Yes [XNo
❑ Yes [XNo
❑ Yes No
❑ Yes No
❑ )'es No
❑ 5'es o
❑ Yes /❑ No
05103101

Facility Number bate of Visit: Time:
10 Not Operational 0 Below Threshold
[] Permitted [3 ertified [3Conditionally Certified [3Registered Date Last Operate or Qbove Threshold:
Farm Name: Ei County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: 1`,<0n . _ — — Integrator: IM
Certified Operator: Operator Certification Number:
Location of Farm:
[]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 C� K Longitude 0 '
Design Current
Swine Ga aci P,o ulation
❑ Wean to Feeder
Design CurrenE Design Current
$oultry Ca aci P,o ulation Cattle Ca acity P,n tulation
❑ La er ❑ Dairy
❑ Feeder to Finish
❑Non -La er
❑ Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
Total Design Capacity
Total SSLW
❑ Farrow to Finish
❑ Gilts
❑ Boars
umber of Lagoons
Bolding Ponds 1 Solid Traps _
❑ Subsurface Drains Lr,,,,t-JIEI Lagoon Area
10 S rav Field Area
❑ No Li uid Waste Management System
IN al
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number::6n — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate, gained markers with required maximum and minimum liquid level
elevation markings?
N'Vaste Application
10. Are there any buffers that need maihienance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PANT ❑ Hydraulic Overload
I2. Croptype
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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 facilin, is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records & Documents
37. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ Vi'UP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21 _ Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. rail to notify regional DNVQ of emergency situations as required by General Permit?
(ier discharge. freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
30 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ommentsN� � {refer to' goes3�on":'Eip7am;aiey YF�'snssvers sudloratty trexwmme7xdatio3ts:or mry other comments.
Use drawings of facility to better explain situat�otis (use addihonii! pages at necessary) ` �❑ FieldCopy W ❑ Final Notes
Av_
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:—3C��r►?
0510310I - - Condnued

Type of Visit 6 Compliance Inspection 0 Operation' Review 0 Lagoon Evaluation
Reason for Visit _.G'62outine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number hate of visit: t?Z Time:rO
Not Operational 0 Below Threshold
U Permitted ©C
ertified 13C�o-n-ditionallv Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name:
1Ta'V-I •yt L /'ems ~r r%'t "54 County: Ohs%0w
_
Owner Name: ��'' ` ah Ho wcfrd Phone No:
Mailing Address:
Facility Contact: 'Title: Phone No:
r,af� o� �aw ^d�r��tdo r h,
Onsite Representative: _ . Tk412 L� Integrator: .��% _
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a �' �u Longitude 0 �• r ��
Dischanpres_ & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
❑ Yes ,TNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZfNo
❑ Yes E5No
❑ Yes ONo
Structure 6
Freeboard (inches): 3%
05103101 Continued

Facility Number: 67 — 3
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 9 No
❑ Yes �21No
❑ Yes �No
❑ Yes )Z'No
❑ Yes 2 No
Waste Application 1
10. Are there any buffers that need maintenance/improvement? ElYes ,YJ No
11. Is there evidence of over application?? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes J2 No
12. Crop type r3�r+�U O�ot h1,14
13. Do the receiving crops differ with those d signated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes O'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONO
b) Does the facility need a wettable acre determination? ❑ Yes 2No
c) This facility is pended for a wettable acre determination? ❑ Yes ONO
15. Does the receiving crop need improvement? ❑ Yes ONO
16. is there a lack of adequate waste application equipment? [:]Yes P?rNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 12rNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ZNo
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) lYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 0 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes IffNo
24_ Does facility require a follow-up visit by same agency? ❑ Yes �2rNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �NO
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coatments (refer.in quei stion #): `Espisin any YES aasvrers and/or.any,recommet►dattiins or suv other'comments.
Use drawings of:ac:.ity obetterplinus:(tsddrtnlpagessaearv) Field Copv❑FFinal Notes
TL,�s ,� �•�• ►S 6e►^.9 ah e_X rclieig4 Gar-�d; ►'o� . 7�1,e
.sw f-ea a•kef la90an it W-91) yv2atn ; C UI-eX . __rje 6e r•----udal
G ,� olv i S e ac G e 1 j e P,,4 .
e a+Xcrty aria daAed W14t1.,, 'yodel sue'
r9. 3e xvl-e 4a use 4 wc,sJ��5
4ke AI /. 1�'e-, �i o� even-F-s Cglcvi44e 41,e ni'4e.-y"i apt J;eat en -h,&
at�p f i � � �•, rcGord(S; *e 4IYjp2_ a -lq ( 415 iS 6e7-,, ) USed �and.'h�ed�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Id Q ZEl
05103101
Continued

1411 !o Z
G j Facility Number: — 3 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
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt_
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any :major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing 6r
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 0No
❑ Yes )�T`ivo
[--]Yes n No
❑ Yes �'o
❑ Yes No
❑ Yes ❑ No
Additional Comments and/tor Draivings:=. Z
p ]
OrC,0n+J"''/eA) fd'� AVIV�`t ZQQZ �! p�i CA' ;On-;/ b✓+ -yoct skeci-1A use
the tQ/2-1 16Z ana[71,'s 41,tvA is 1r1 M01ezy5 of 4Ae A✓Ou.s4 ev--,14
Also d;.screpe►,�cy k4we-2n 4i�e ueagje �jei�lc,
USe ar7 eke a�a�plicA�;6h ,�Go�Gls Q+.-o( 4tke j�r,'�ci-l��,G�es✓;9►i .
f�jea sP c0v1�QG� �:-�Q J7is-,!✓++G�.foi'� Gva-�f �f '.Ge And qs�
o1crct-9f ql eL-✓ L,9 t'4 L7
re�'lec-�'� y��r �rft"�g�ro� •acj�,'c�s. �l�o;-��ler� �.�-�c,�,d
.�. �n -tltP r P6,1 �;oh
�;{.��en-�-�'!a.-✓ rq-�es bar � use n�
Jqe1ve fIie q '-"d use &k' �Ae
q��j; Lq.:a+� ✓PGo�dS� Sa,l-�Wti�ic� av1oL e>c-}er�S,'oh el"La"7 Pe-
[e.rceds- 4o be 6c�a es4ab1;Aec(.
a •� � �
P tn+
a ve., q 11� 4 ;_3 lea, k ;S tMgin-}a,"-,ed r''1 q"e:xCcIle
n
cbnd,4;oh a"d, --t4e erp,,,,fs 4a keep 1.4 iti 9add ar�def �fe
ev ; IAe,I+ a k\d ap1Oeec; R4M
05103101

z 'D_iv1s onafWateQ� Lw: tY
� 0 Diy�sion of Sorliand-N!atee & era n
- -u�
`-�
Type of Visit Xcompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up Q Emergency Notification p Other ❑ Denied Access
Date of Visit: -� Time:
Facility Number
0 Not O erational 0 Below Threshold
Permitted © Certified © Conditionally Certified © Registered Date Last OpeM<-t-j
Above Threshold: .........................
G�i.�-e..... ....... Coup :.
Farm Name : ............. .................................................. t3
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
Mailing Address: ..................................... .........................
..... ...........................
Onsite Representative: l� �G` �'� �Ct vl, Integrator:.... `��
Certified Operator:
Location of Farm:
................................................................... Operator Certification Number:.........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 4k Longitude �� �i i6
Design Current
Swine Canacity Population
❑ Wean to Feeder
Feeder to Finish
33
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number ofLagoons " ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdrng Ponds / Sohd Traps ❑ No Liquid Waste Management System
.r:.::....._ F . ,
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes 0No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is obser- ed, did it reach Water or the. State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ONo
.I
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )<No
01/01/01 Continued

Facility Number: — 3
Date of Inspection Gj
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: p
Freeboard (inches): .............
.f1............. .................................... ................................... .... ............................... ...................... ............. ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes allo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ZNo
(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 XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes j0o
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes j�[ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes CTNo
12. Crop typevc�c`�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
kNo
b) Does the facility need a wettable acre determination?
❑ Yes
OdNo
c) This facility is pended for a wettable acre determination?
❑ Yes
ArNo
15.
Does the receiving crop need improvement?
❑ Yes
KNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
17.
Are rock outcrops present?
❑ Yes
NrNo
18.
Is there a water supply well within 250 feet of the sprayfield boundary? Unknown
❑ Yes
❑ No
On -site Koff -site
Required
Records &Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
,Yes
❑ No
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
9No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
k"o
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
kNo
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
�Mo
(ie/ discharge, freeboard problems, over application)
❑
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
26.
Does facility require a follow-up visit by same agency? '
❑ Yes
WNo
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NNo
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
WNo
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
XNo
01/0l/01
Continued

KJ s
Facility Number: — Date of Inspection UI
Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan biade(s), inoperable shutters, etc.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes b(No
❑ Yes ONo
❑ Yes XNo
❑ Yes � No
❑ Yes Pq No
A No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
JAG Ili ilWlil�'1 VI LQlllli}' W 1JCLlCI CxillcUll _,iLLLQlIViLI �117C-dUlill.lUlldl �ld]j'CS iW nClgiul ]'J, k,'
❑Field CaFY [I Final Notes
RK-1 cps �►-� t
�
o's
Wit..__
V60
CZ-5C.A\-�1 OCICA �IQIQU
walU A, 3111z,
01/01/01

f a , 'yNumber 3 Lagoon Number .A Lagoon Identifier p���
y --ypvk.!nt!�� .....................................
�Active O Inactive Latitude FS-M Longitude M 1�j M
By GPS or Map? JKPPS ❑ Map I GPS file number. F6-r i a, m m :63
35. Surface Area (acres):
36. Embankment Height (feet):
37. Distance to Stream:
38. Water supply well within 250 ft of the lagoon?
1111.,
Ed On -site ❑ Off -site
PUCT-
39. Distance to WS or HOW (miles):
40. Overtopping from Outside Waters?
41. Constructed before 1993 NRCS Standards?
42. No verification of adherence to 1993 or subsequent
NRCS Standards?
,kess than 300 ft O 300 ft - 1000 ft O greater than 1000 ft
*Yes _1A No %�� (s 9S.— arn/
0<5 05-1010
XYes O No O Unknown
XYes O No O Unknown
O Yes O No O Unknown
43. Was groundwater encountered during construction? O Yes O No Xunknown
44. Depth to Groundwater: Kunknown
p Yes XNo
Yes XNo
O Yes kNo
IQg
45. Spillway?
l
46.dequate Marker?
47. Immediate threat to the integrity of the structure?
48. Freeboard & Storm Storage Requirement (inches):
—2
,C e g-.,;,d 3Iola

nutine O Complaint O Follow-up of DW ins ection Q Follow-up of DSWC review O Other
Facility Number Date of Inspection � --Q6
Time of Inspection U G 24 hr. (hh:mm)
o(Termitted U] . Certified 0 Conditionally Certified © Registered R3 Not Operational Date Last Operated-
t-� � ................... -.....
Farm Name: ) U.! -�.� Coun......................................... -
.....................................'-��..................................... �....
OwnerName: ---------- -- - - --- ----- -------------- --------------------- --- -----------.................... Phone No; ....... ....
Facility Contact: ... Title: ................................................................ Phone No: ...................................................
MailingAddress:.................................................................................................._......I............................................................................................... ..........................
Onsite Representative: .. Integrator:...... !---..................................................
Certified Operator:_
............................................... .................. I ...... I ...... 11 ......................... Operator Certification Number:..........................................
Location of Farm:
Latitude �' 0` ��� Longitude
_ esign ,, arrant Design urrent : Design Current
$wine Ca aci - Population Poultry Ca aci : Po"ulation Cattle 7_ ....Ca Mactt Po ulahon
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish °.-. ❑ Non -Layer ❑ Non -Dairy '''
❑Farrow to Wean-
- ❑Farrow to Feeder ❑ Other _
s
Farrow to Finish
Tatar Design Capacity
❑ Gilts
❑ Boars Total SSLVV
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [INo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ANo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):�0 .......................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes KNo
seepage, etc.)
3/23/99 Continued on back

• Facility Number: Date of Inspection Gp Printed on: 7/21/2000
-_5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El 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 •KNo
(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 j gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes tTNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement'? ❑ Yes NrNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes N0
12. Crop type 1> h
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes I'No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
9No
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
R(No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
U(No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
XYes
❑ No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
,ryes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N'No
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
14No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
)RrNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
O'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
2No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N�No
.
. . . Vi...... .O..... eti. . .were . ..e . d. . .V. . ...oiwill receive i. further
Coiris 6fide' e*al)"f th' isit........'.'.'.'.'.'.'.'.'.'.'.'.•.'.•.".'.'.'.'.'.'.'.'.'.'.'.'.'.'.. . .
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
1i 1Q_- ?I 5-3 (TOG
Reviewer/Inspector Signature: (_ -- Date: yr .—IOd 5100

Facility Number: Tn — 3 Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )�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
3 t. 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 XNo
QC� " 5�--� � �G'� �� C 7� �' Yl-LQ��J-i �� l � �' �V \ CGf•�i
tc
V NAG� P� CKGQ psi — s� ass
Vri LZJ�3-
r
F
jQ1 J�-' �L'
koun� wn�(
5100
J

V
Facility Number Date of Inspection - J
Time of Inspection E3 24 hr. (hh:mm)
13 Permitted IX Certified © Conditionally Certified © Registered [3 Not Opera— 777l Date Last Operated:
FarmName: ...h. Wg! - 7..... f3 M 5....................................................................... County: ... V! w..............................
Owner Name:... / /L /t?/J....... Z) ............................................................... Phone No: .---• c .. 55 ................ ..................-.....
FacilityContact:..............................................................................Title:.....................-. ... Phone No: -•-..........................................
Mailing Address: 5.S65.... G. ?M.......
p..... ............................. ..J G...-....a� ..............
Onsite Representative: L?o4 /hheQGl N...../�Inte rator
........... ....................... ..........u�............�/�... ............. ......... Certified Operator :...... ..... ........................ ......11diVI; �...... ........... I...................... Operator Certification Number:.... t7.'MA ...........
Location of Farm:
.........................................................................................
Latitude 3CS "
`'Design Current
SWARe Vnnneity Pnnnlation
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
.........................................................................................•--............---•----. .---..-...
Longitude
Design
Poultry -,"Capacity .
C6rrent
Poptlation Cattle
❑ Layer
❑ Dairy
❑ Non -Layer
❑ Non -Dairy
....._... ..
❑ Other
Totai Design Capacity C
Total SSLW
�Numbeir-of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area
Holding.Pondls / Solid Traps - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made"?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Design Ctirrent
,apacity Population
3a 7 /
J�S
I Spray Field Area
❑ Yes �KNo
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes D(No
❑ Yes RNo
❑ Yes R110
Structure 6
Identifier:
Freeboard(inches): ......�4 ........................................................................................................................... ............ —............I...--. .......... I........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

{ s
r
Facility Number: ��— 3 Date a#'Inspection /J/��
6. Are there structures on -site which are not property 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 kNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 14No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? kyes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes &No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes *o
12. Crop type A� — Z!gt'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes k No
14. a) Does the facility lack adequate acreage for land application? 0 Yes N�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 CJ�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
WO
Recnuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�fNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
14 Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
W Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
V`No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
J4 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes RNO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 4No
24. Does facility require a follow-up visit by same agency? ❑ Yes *0
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
... . viol'at>Eor. .deficiencies mere poted c�irrtng this visit: Yoir wig. i•eeeive Rio further
corresponden* & about. this visit_ - _ '
Cotriments (refer to question #}.^'Explain any YES answers an d/orany.recommendaitons or any other commeets:
-_
Use drawings of facility to"better explain srtii<ations: (use additional_pages as necessary)� _
Reviewer/Inspector Name { _ �— � X
Reviewer/Inspector Signature: Date: //.
3/23/99

-Wility Number: G — 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 R 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 XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes AZNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes &0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 2�rA[o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
Mclitional Comments an or raw�ngs
a-
J/23/99

t
• i
Lagoon Dike Inspection Report
Name of Farm / Facility
Location of Farm / Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Sq. Ft.
Upstream Slope, aH:1V
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Manion Howard (Howard Farms) 67 - 03
SR 1316
Marion Howards, 5585 Gum Branch Road
lacknvffle-NC 28540 910-3 4-3552
9 / 27/ 99 Names of Inspectors Zahid_ Khan _
Vincent LM8ds ._
6-8 Freeboard, Feet 2.0 - 2.5
150,000_ Top Width, Feet 8 - 10
2 to 1 Downstream Slope, aH:ly 3 to I
Yes X No
Yes X No
Yes X No
god grass c yer , No trees tic.
Yes X No
Yes X No
Yes x No
If Yes, Depth of
Overtopping, Feet
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X No
Other Comments PrcM shape, Bottom drain working_ Clean water
coming m fte pipe.
a
V/

W.
Revised Apal 20, 1999
JUSTIFICATION & DOCUMENTATION
Facility Number
Farm Name: -
On -Site Representative: #%_
FOR MANDATORY WA DETERMINATION
99
V O eration is fla ed for a wettable
P
acre determination due to failure of
Part It eligibility item(s) F16) F3 F4
Inspector/Reviewer's Name:
Date of site visit: lI
Date of most recent WUP: % __A2
f7
Annual farm PAN deficit: d, pounds
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable -acre
determination based on P1 P2 P3
Irrigation System(s) - circle 1. hard -hose irave er center --pivot system; 3. linear:Ynove system;
4. stationary sprinkler system w/permmanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/porlable:pipe
L-;eferm[nation Exemptions (Eligibility failure, Part 11, overrides Part l exemption.)
E1 Adequate irrigation, design, including map depicting wettable acres, is complete
and signed by an 1 or PE.
E2 Adequate D, and D ID3. 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.
2-4 75% rule exemption as verified in Part 111. (NO i t:7b % exemption cannot be
appiied to iarmss-that rail the eligibility checklist in Part 11_ Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational .table in Part 111).
PART If.75% Rule Eligibility -Checklist and -Documentation of WA Determination
Requirements. WA Determination -required because operationfails�one of: the.eligibiiity
requirements listed-telDw:
F9 Lack -ofmc.reagewhich-resulted in:ove;-mppiicaiion:Df-was--w-aterz-(P.AN) Dwspray_
/ nnld(s)�ccordingrto-iarm'sdast�woy�. earsmimgaiienaemrds_
✓ s`2 Unclearjllegible,-or lack of inforrnabontrnap.
_F3 Obviousaieldiimitabons_(numerous:iitches-riadiur$tto:d'--d� cctiequired_,.::. .
buffer/setback:acreage;�or25JaDtfotaf�creage deniineddn`-CAWMP0tidudes_ =_-:
small, _irregufariy:shapedMelds= fields_lessihan:5�creslDrtavelers:Dr_fessdhan
2 acres-for,—taiionary:SDdnklers).
F4 WA determination required because CAWMP=credits7ield(s)'s acreage -in excess =
of 75° o of the respective field's total acreage as noted in fable in Part 111.

ill
Facility Number -
r
Re-ised April 20, 1999
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP FIELD COMMENTS3
NUMBER NUMBER'.2 IRRIGATION ACRES ACRES %
SYSTEM
k k
k �
{ k I I
k k k k 1 k
k k f k i I k
FIELD NUMBER'-hydrant-pull,zone-or -point numbers -maybe used in place -oifield numbem-depending on.CAWMF
and type of irrigation -system._. If pulls,-eic.-cross-more-than -one field,-inspeciodreviewer will have to combine7felds to
calculate 75% freld.by field determination for -exemption; -otherwise operation will lie subject to WA determination.
FIELD NUMBER2 --must be.cleady delineated on-rnap.
COMMENTS' --back-lip fields -with CAVVMP_acF agemxc,eding 75% of its lotalacresand'havinaTeceivedJess than 50%
of its annual PAN -as:iocurnented-inthe_:arm's-previousdwoyears'.(] 997.& 1998) -ofirrigation-records,-cannot-serveasthe
sole basis-iorrequiringa WA,Determinabonz—Backt upzreldsmlust:?enot°dinfne-r-omrnentsectonand=st:be2accessible
by irrigation -system. -
Part IV. Pending WAI)eterminations-
Pi Plan Jacks following information:
P2
Plan Tevision-may-satisy75%-rule based .on:adequate .overall -PAN deficit and by
adjusting -all neld:acreage:to-below 75% use Tate
P3 Other (Win process of.installing new irrigation system):.

Revised APHI 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facilit Number � 1 �./Overation is fla ed for a wettable
Y 7 -99
Farm Name:
On -Site Representative:.-dr�.
InspectorlReviewer's Name: i
Date of site visit: S li
Date of most recent WUP:
Annual farm PAN deficit: ­02. pounds
f
acre determination due to failure of
Part 11 eligibility hem(s) F1 Cam' F3 F4
Operation not required to secure WA ---
determination at this time based on
exemption E9 E2 E3 E4
Operation pended for wettable acre
determination based on P1 - P2 P3
Irrigation System(s� - circle 9. hard -hose rave er ..center --pivot system; 3. linear --move system-,
4. stationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system wlportable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlport.able :pipe
r�".r i :_ ;termination Exemptions (Eligibility failure, Part If, overrides Part f exemption_)
E9 Adequate irrigation design, including map depicting wettable acres, is cornpfete
and signed by an I or PE.
E2 Adequate D, and D21D3. 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.
i=4 75°!° foie exemption as verified in Part [II. (NO i -75 % exemption cannot be
anpiied to farms -that fait the eiidibilky checklist in Part 11. Complete eligibi5ty
checklist, Part Il - F1 F2 F3, before completing computational fable in Part 11I).
PART If.75% Rule Bigibility.Check[ist and -Documentation of WA Determination
Requirements., WA Determination inquired because operation failsDne of The eiipibilrty
requirements iisted:befow:
F 1 La--k-or:acreage_which-Tesul£eddnmve-mpplicaiiormf wast--%-zier_(P_AN) on.-ispray-
field(s)�ccordingiodarm'sdast woyeas��rrigan na cazds-
✓ F2 Unclear rillegibie;or lack -of inronrationlrnap.--
_F3 Obviousjieldiimitationslnumerousilitchat;:ailurB:-io--deduc�egdired_�.:
bufferlsetbac#��craage;mr25%oi:total-mcreageadehtinAldSd!DAWMM- ribludes
small,-.irregularly-zhapedm-elds--fields_lessfnan�:'a' creslor3welersz dess-than:-.=
2 acres -forztationarysprinklers).
F4 WA determination -required because CAWMP=credits-.P-eld(s)'s acreage,in -excess:
of 75% of the respective field's total acreage as noted in table in Part III.

Rcvistd April 20, 1999
. Facility Number--.
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
. TRACT
FIELD
TYPE of
TOTAL
CAWMP
FIELD
COMMENTS3
NUMBER
NUMBER'S
I
IRRIGATION
ACRES
ACRES
%
I
SYSTEM
FIELD-NUMBi=R'- hydrant-pull,zone, -orpointnumuersmmybe used in place-orfield nvmbers'deDending on CAWMP
and type of irrioauonaystem: If pulls, etc: cross--nore-than-one fieldJnspectDdreviewer Wlll have tD combine -fields to
calculate 75% field .by field determination for exemption; -otherwise operation will be subject to WA determination.
FIEM.NUMBEW - must be clearly delineated nnznap-
COMMENTS' --back-.up nelds.with CAWMP_acm...agnzecceeaing 75% of its#otalmcres-and havingTeceivedJAYs Lthan 50.0
of its annual PAN -aszfflLvmenteddnthe _ farrn'spreviousdwD_years' (1997 & 1998)nfirrigaiion-mconcis cannot-servems-ine
sole -basisfor-Tequiringa WA'Dsterrn_inauon=�Back-un-iieldsmusifi#mDied-inine7comment:seciion:andTnust:beac:essibie
by irrigation zysiem.
Part IV. Pending WADeterminations -
Pi
P2
P3
Plan JacksfoIlowinginformation: --
Plan Tevision-may.saiisfy�d%-rule-based Dnadequaie-overall.PAN deficit -and -by
adjusting -all neld:acreagedo_below75% useTate
Other (iefin process of.installing new irrigation system):,

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
June 23, 1998
CERTIFIED MAIL
RETURN REC PT REQUESTED
Marion Howard
Howard Farms
5585 Gum Branch Rd
Jacksonville NC 28540
Farm Number: 67 - 3
Dear Marion Howard:
&74
0!�Ll
NCDENR
NORTH CARoumA DEPARTMENT OF
ENVIRONMENT AND NI:rLiRAL RESOURCES
You are hereby notified that Howard Farms, in accordance with G.S. 143-215.1 OC, must apply
for coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your farm
has sixty 60 days to submit the attached application and all supporting documentation. In accordance
with Chapter 626 of 1995 Session Laws (Regular Session 1996), Section 19(c)(2), any owner or
operator who fails to submit an application by the date specified by the Department SHALL NOT
OPERATE the animal waste system after the specified date. Your application must be returned
within sixty (60) days of receipt of this letter. Failure to submit the application as required may also
subject your facility to a civil penalty and other enforcement actions for each day the facility is operated
following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package.
The signed original application, one copy of the signed application, two copies of a general location
map, and two copies of the Certified Animal Waste Management Plan must be returned to complete the
application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any questions concerning this letter, please call at [phone] extension or Dave
Holsinger with the Wilmington Regional Office at [phone].
Sincerely,
�r A. Preston Howard, Jr., P.E.
cc: Permit File (w/o encl.)
Wilmington Regional Office (w/o encl.)
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of InspeTtion 24 hr. (hh:rrtm)
© Registered Certified] Applied for Permit ©Permitted Not O erational Date Last Operated: --
FarmName:......... kj :'tom }�.... .r a!2 VL._5............................ County: .............................................................. .......................
Owner Name:.........' 2 / Phone N'o:........... 7 .. 3.$.z'................................ L. ............... .......
Facility Contact:
........ Title:...... ................................. Phone No:...................................................
cb
Mailing Address :....................................... .! ...................................................... .....................................................................................��.......
OnsiteRepresentative: ........................................................,.../.........-..................................... Integrator:....... ^. :`................................................
Certified Operator;-.-.%r� � .CVV .....................[��-A- '�.....-............ Operator Certification Number:.......�.7..�J. ��.. ...
Location of Farm:
Latitude • ' " Longitude ' 0' "
G Design - .Current t Design Current '< f� Design Current
h Swine XCapactty:oPopulabon
r €.
Poultry ,, Capacity FPopplahon ; Cattle Capacity PopEelahon
• ❑Wean
,
❑ Dairy
❑HNon-Layerl
EEJr
❑;; ❑Non -Dairy
❑ Other
Y4 ,Total Design'Capkity"
;
Total SSLW
Yin,
w
w.
Number ofLagoons'/ Holding Ponds
❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
to Feeder
Feeder to Finish
=�
❑Farrow to Wean
Farrow to Feeder
❑Farrow to Finish
Gilts
oars
General
I. Are there any buffers that need maintenance/improvement? ❑Yes 19 No
2. Is any discharge observed from any part of the operation? ❑Yes 0 No
Discharge originated at: ❑Lagoon ❑ Spray Field [I Other
a. If discharge is observed, was the conveyance man-made? ❑Yes b2 No
b. If discharge is observed, dill it reach Surface Water? (If yes. notify DV4Q) ❑Yes JO No
c. 1f discharge is observed, what is the estimated flow in raUmin?
A. Does discharge bypass a lagoon systemVV '? (If yes, notify DQ) El Yes Z No
3. Is there evidence of past discharge from any part of the operation? El Yes P No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes ®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes 0 No
maintenance/improvement?
6. Is facility not incompliance with any applicable setback criteria in effect at the time of design? ❑Yes 0 No
7. Did the Facility fail to have a certified operator in responsible charge? ❑Yes 0 No
7/25197 Continued on back

.1, Facility Number: — 3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 45 No
Structures (Lagoons,11oldine Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes O�No
Structure ) Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ........:................ ................ ..................... :......... ......................... ................ .................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes ZNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
❑ Yes
No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) '
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
I5. Crop type..........ZA..r..............................................................................................................................................•----..---....._.........................._...............__.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
9 No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
ONo
18. Does the receiving crop need improvement?
❑ Yes
ZNo
19. Is there a lack of available waste application equipment?
❑ Yes
Z No
20. Does facility require a follow-up visit by same agency?
❑ Yes
[UNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Cl Yes
0 No
22. Does record keeping need improvement?
❑ Yes
0 No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily availabie?
❑ Yes
Kj No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
AYes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
U�No
0 No.vioIations or deticiencies. were noted -during this: visit.- :You.will receive no ftirther
: correspondence tib:out this.visit.
Comments (refer' tti question #) Explain .any YESEanswers and/or anv recoiiiinendations orany other eomments ,
Use drawings of facility to Netter explain sEtuattons (use addttional pages`as`necessarv) n >
f
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7/25/97

0 Routine O Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Date of Inspection 14, H
Facility Number
Time of Inspection .([�D� 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ® Registered ❑ AppIied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review 7.O
❑ Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated: .. _. _ _ ....... - ... .... ......
Farm Name:
. ���...._.......,.�. ^.j-wtWS --------•••- -- --- County."
.......'Q.s d-..�_...-........... _.....................
Land Ovvmer Name:a.A-) . -.740w!4 kD ... ......._..... _ Phone No:. '-�Z` _.. _Z..:__...............
Facility Conctact: !l 14 2 c O A) f lac✓ �} � Title: OcvAJ 5— Phone No: - w .. � .. . �....... _ .........
Mailing Address:. Y U!? /3lLrrn 1Cf!'`?� __. _ cu c -IGSo n 1 J�, _ _ .-flSaQ
Onsite Representative: ..-a�ri �7 a'`). _...-ic�w'°k!Q �......._.... _.- _ Integrator: ..........
�....
Certified Operator: „M.ri.2- � � ._.. 1+0 „'U"t 2:-D „�..., ... Operator Certification Number:
Location of Farm:
Latitude [�:]• ®4 u Longitude �• ®4 ® u
Type of Operation and Design Capacity
Des C Trentx x e Cnirent �� es
z Ga aril P,o' aiati E'W{Po ti `staon RiCa`ac�Po uon
Svvtne Poultry ,Ca acitvCattte g
❑ Wean to Feeder xff La er ❑ D '
m ® Feeder to Finish Non La er [] Non-Dairyl
Farrow to Wean h
Farrow to Feeder,; Total Design Capacity T ,
Farrow to Finish
n:..� w Tatal SSL �Z v
��� ❑Other � � l � �` � �
M.
wff
ft emu'
TM
Number of Lagoons / Hotdtng Ponds ❑Subsurface Drams Present
>�F� ❑Lagoon Area ❑ Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes B &o
❑ Yes [RNo
❑ Yes ID'No
❑ Yes EV o
❑ Yes
B No
❑ Yes
❑'go
❑ Yes
0<0
0 Yes
❑ No
Continued on back

Facjlity Number: .... (e.7■-.........
:J 6.' Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes [� - o
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Struc awes 1a agoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
2.3
10. Is seepage observed from any of the structures?
❑ Yes &<O
❑ Yes B'I�o
❑ Yes ['fo
Structure 4 Structure 5 Structure 6
❑ Yes M o
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
BNo
12.
Do any of the structures need maintenance/improvement?
❑ Yes
9'1 o
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
&KO
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
GKo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type r,5,
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
BlNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[ No
18.
Does the receiving crop need improvement?
0'�es
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
RIo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
Er-�7o
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
01�o
For
Cetfified Facilit4gs Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
24.
Does record keeping need improvement?
❑ Yes
❑ No
Comments (refer to'gi estipn #) �Explam any YES answers and/or any recommendations or any other comments _ � t
Use drawings of facility to better explain situations use additional pages as necessary)
SpRa� }`tl� k4�+S t'3�Lh S�r'1940 t.t? 04Y
4
"j1.1fS T�rr.t Cou z.dL ��P CS�s vF val-+c<rt coeo w c,.,t�LDs
r►,n. "OwAoeo wi I1 sj,� S Pr`�
a
Reviewer/Inspector Name5.
ReviewerlInspector Signature: /.S „�G ,r`,� _ Date: Z' /'9 7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. & Z
DIVISION 01 ENVIRONMENTAL MANAGEMENT
AND AL FEEDLO OPERATIONS SITE VISITATION RECORD
ATE: l 1995
Farm Name/Owner.
Mailing Address:
County: —
IntegWor.
On Site Re
Physical
ive: M/}Qro AJ
Decat*on: _
t a r+__-in 140
rr4 r+�; Oar 0—
Type of Operation: Swine _Le
Design Capacity:,
DEM Certification Number: AG
Latitude: _ 3 _' 1f, 0 Z"
Does the Animal Waste Lagoon ha,
(approximately 1 Foot + 7 inches)
Was any seepage observed from the
Is adequate land available for spray
Crop(s) being utilized: C,0 r
Does the facility meet S minima
Is the animal waste stockpiled wit!
Is animal waste land applied or sp
Is animal waste discharged into w�
similar man-made devices? Y
Does the facility maintain adequat
spray irrigated on specific acre
Additional Comments:
W
e Zj j
Phone-
Phone: q 3 2 q 35S
IA'a's-t Sul" f—T- 5P- 13 f 4 3 TUv n
"krit 14. i-n +
Poultry Cattle
Number of Animals on Site: 1 600
DEM Cerdfication Number: ACNEW
Longitude: 7-)_' _' .7 ' Elevation: Feet
Circle Yes or No
sufficient freeboard of I Foot + 25 year-24 hour storm event
es or No Actual Freeboard: -'5__-_Ft. _ Inches
lagoon(s)? Yes or Was any erosion observed? Yes
es o
r No is the cover crop adequate? Yes or No
? 200frs- or Nosetbackcriteriar_v
100 Feet from Wells? & priNo
n 100 Feet of USGS Blue Line Stream? Yes or"
y irrigated within 25 Feet of a USGS Map Blue Lire? Yes or••'No
ers of the state by man-made ditch, flushing system, or other
; oN If Yes, Please Explain.
waste rianagement records (volumes of manure, land applied,
ge with cover crop)? rYes r No
Inspector Name Signature .
cc: Facility Assessment Unit Use Attachments if Needed.

�J
•
ti
OPERATIONS PRRNCH - WQ Fax:[phone] Jul 24 '95 18:05 P.07/18
1 Site Requires immediate Attention NO
Facility Number:
SITE VISITATION RECORD-
DATE: �y , 1995
Owner: _ ,t,T ,o �. ,6 �lu� r cf Farm Name:
County: �& S�Q W
Agent Visiting Site: _ C.S _ 'Phone: 9d. _5� 5��- I4/? z_
Operator. yr , a vim_ w�v - Phone: _9/U Z-SSA On Site Representative: ~�D.cu a 1,0 Phone:
Physical Address:
Mailing Address: S" 5- 6'
Type of Operation: Swine Poultry Cattle
Design Capacity; 14 6 Number of Animals on Site:
Latitude: 0 �' " Longitude: O
Type of Inspection: Ground Aerial
Circle Yes or No
FE
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately l Foot T$ il74lic`ti1t or No Actual Freeboard: .? Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes og�p Was there erosion of the dam?: Yes o>�
Is adequate land available for land application? 'esesr No Is the cover crop adequate? 6�ar No
Additional Comments:
Fax to [phone] Sigrrature of Aat