670010_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: UCo ance Inspection U Operation Review U Structure Evaluation U Technical Assistance / I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access V
Date of Visit: Arrival Time: 2 o Departure Time: F I Q 4 County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: lJ'il6#irq
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Region:
Certification Number: 16 71 f
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
airy Cow
can to Feeder
Q 50 g
Non -Layer
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
P,o
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
D , P,oult .
Layers
Ca aci_
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
If
Other
Furke s
urkey Poults
Other
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
[] NE
[:]Yes
❑ No
D NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes rNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3
21412015 Continued

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

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm4 ❑ 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.
❑ Fai ure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ED"No ❑ NA ❑ NE
❑ Yes ZfNo ❑ NA ❑ NE
❑ Yes E o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #):.Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility,.to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: n 17 3 P
Date: ro
21412115

Type of Visit: Q Conppliance Inspection V 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: ; (, Arrival Time: 9 vo Departure Time: 9 $ County: OAJSU W Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Owner Email:
Phone:
Integrator:
Phone:
Certified Operator: Certification Number: 16,13 q
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
I
Design Current
Wet Poultry Capacity Pop.
ILayer
Cattle
Dairy Cow
Design
C►apacity
C*urrent
Pop.
Wean to Feeder
3T9p
I
jNon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
-T-si
D . P,oult , Ca aci I;o ,
I Layers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turke s
Turke Poults
Other
Beef Brood Caw
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes E2 /No ❑ 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
FEI/No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
6-N/o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: 6'q - I C5 Date of Inspection: { WAS
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: j
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
E-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
0 No
❑ NA
ONE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment
1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
7 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
f�/No
C] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA
❑ NE
maintenance or improvement .
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes To ❑ NA ❑ NE
❑ Excessive -Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Vivo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rN
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Sludge Survey
X0
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: G,
24. bid the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ YesVNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 1Vo ❑ 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 hJ 1Y o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes To ❑ 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 F-,a" o ❑ NA ❑ NE
❑ 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
❑ Yes
❑ Yes
KNo ❑ NA ❑ NE
V❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
aHts2il�;C�
Phone: aoj)� -r (—) A
Date: 1 u'
/Is-
2,412014

I"
Type of Visit: Q$ Co pliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: 0 RoutinComplaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access_
Date of Visit: 1 Arrival Time: D Departure Time: ® County: ON5(,6h/ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 't_!�AaJg aA Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Cattle
Dairy Cow
Dairy Calf
Da4y Heifer
Design Current
Capacity Pop.
Wean to Feeder
3 (}I INon-Layer I
Feeder to Finish
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D , P�oulti. C*_a aci_ Pla ,
Layers
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes o ❑ NA ❑ NE
❑ YesFNo ❑ NA ❑ NE
Yeso ❑ NA 0 NE
Page I of 3
21412011 Continued

Facility Number: V) -1D jDate of inspection: S
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: 21ACsoO�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): liv
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [240 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 6/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 [3/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes mlxo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes [I/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):
l4. 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 &, o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes f No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [:2/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes C;3"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 YNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes jyNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - fj> I Date of Inspection: t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes MA❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes V ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 2/N/o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [2/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 N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes YNo
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or.any additional recommendations or any other comments._
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/InspectorName: Z.O t') Phonek%l 3 a
Reviewer/Inspector Signature: Date: 5
Page 3 of 3 2112011

Type of Visit: 0 �Rqqptine
liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Co (ZA 3 C& —ir
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 91
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop. Cattle
La er Dairy Cow
Design Current
Capacity Pap.
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
Farrow to Finish
D . P,oultr. Ca aci P,o P. Non -Dairy
Layers Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number; - Date of Ins en:
ctio
i
r
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
Identifier: LA LT�J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): vIy
Structure 2 Structure 3 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?
dNo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes (ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E!(No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Ef o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesWN❑
ND
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes U
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L! N
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes No DNA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EfNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �XN, ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes w No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciliy Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z�wn ❑ 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
LA o ❑ ❑ N NA E
N
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA [3 NE
and report mortality rates that were higher than normal?
YNo
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
7No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes C/�X ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better exulain situations fuse additional pales as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon�
Date: ii

(Type of Visit: (3 ZRoutine
Hance Inspection O Operation Review Q Structure Evaluation O Technical AssistanceReason for Visit: O Complaint O Follow-up Q Referral O Emergency O Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: / $(j Departure Time: County: _04SL W Region:
Owner Email:
Title:
Phone:
Onsite Representative: &QBA" &N600.J Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop. Cattle
La er Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
3 Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Dairy Heifer
Design Current _DryCow
D , P,oult , C*aci P,o , Non -Dairy
_a
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
er
Turkeys
e Puults
r
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ 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)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
To.
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
6ZO
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection: ct
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ 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): `T d
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ltid 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 LJ 1Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [) Yes N ❑ 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
[/ o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
CYN ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes�
❑ NA
XNo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
2 ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Y' ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V.No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - 10 Date of Inspection: g /
24.iDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes No ❑ NA ❑ NE
[:]Yes < ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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 03 N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesVNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or, any other comments ,moo E-
Use drawings of facility to better explain situations (use additional pages as necessary).. "
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2141201
73

Ile! ,, Di��ston of Water Quality
Factll Number �b 0 Dtvtsioit of Soil andtWater}Conservation <�
�.� .
Other Agenc�� s-
Type of visit ef 7Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: uyyp
Arrival Time: Departure Time: County: G/ySLbl�J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: 2 1 Title:
Onsite Representative: BA�&
ARA AITOIntegrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [=c =I II Longitude: =o=, =�I
Design Current ;.. Design Current�� "'Design Current
Capacity Population V1'et Poultry rCapacityPopulation; Cable W 8Ca actyPopufation
❑ Wean to Finish
Wean to Feeder
446
1 1 6
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
❑ Dairy Cow
❑ Non -Layer
❑ Dairy Calf
❑ Dairy Heifer
Dry Poultry.
El Dry Cow
❑ Non -Dairy
'❑ Layers
a ❑Beef Stocker
❑ Non -Layers
❑Beef Feeder
=, ❑ Pullets
' ❑ Beef Brood Cowl
❑
—.. _
.�.
Turke s
Other r ; ,, , ❑
Turkey Poults�'
❑ Other ❑ Other Ni�mber,q
n
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes EXo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
o
El Yes
WNo
❑ NA
❑ NE
❑ Yes 21/No ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: — 110 Date of Inspection o2
Waste Collection & Treatment
4:tls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 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: LACofflJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.) `
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [;No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1,2/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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0
❑ NA El NE
15. Does the receiving crop and/or land application site need improvement?
[I Yes
�'No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
WN o
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
El NA El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L'I No
❑ NA - ❑ NE
Comments.(refer to=gnestion #) Explain -any YES answers and/or any, -recommendations or.any other comments
Use drawings of facility to bitter. explain situations. (use additional pages as necessary): u
Reviewer/Inspector Name a vvN,.I ( � �- 1 Phone t7
Reviewer/Inspector Signature: Date: 3 U
Page 2 of 3 1 12128104 Continued

Facility Number: 67 — Date of Inspection 3 1►
Rqquired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes dt
o El NA [I NE
El Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z o
El NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
C3io
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElU Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Id No
❑ 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?
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
EI/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,.,�
EJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ENo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

f
Facility NumLp
ber 1
•-�IIII�III
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: l Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _Gaj..(a Sc-,,. 1T _
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 ` 0" Longitude: = ° = 6 0 6I
Design Current Design Current Design C►urrent
Swine C*apacity Population Wet Poultry C*apacity Population Cattle Capacity Population
to Finish
❑ La er
❑Dai Cow
Fan
an to Feeder
3 ctceo
❑Non -La er
❑Dai Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
PO Boars
pry Poultry
❑ Layers
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑Beef Feeder
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures: LA
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 IJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
�N�c❑
NA
❑ NE
ElYesNo
❑ NA
❑ NE
12128104 Continued

,,: Facility Number: (pi -- 10 1 Date of Inspection EWE]
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:fb
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �L
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 V(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes yNo
❑ NA ❑ NE
El Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V 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 dNo ❑ NA ❑ NE
maintenance/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes l/J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ]bs [:]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 o
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesW190
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes L/J N
❑ NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes t� No
❑ NA
❑ NE
-
omments (fertqu t<o�n�,,#} Egpl�ama�n�y�S`answers�and/or anyecommendatronslo'r�any other comments.
�Llse�drawu�gs�of faeihty,to,better ezplam'�sttuahops. use=add�ttonal pages as necessary):
Reviewer/Inspector Name �c,, Phone: 9 —
Reviewer/Inspector Signature: Date: lU
Page 2 of 3 1 12128104 Continued

Facility Number: Date of Inspection 121,10
l
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ENo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
&No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,LVNo
L No
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�`No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,�
L/No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ld/No
El 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
No
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[J
❑ 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
[I NA
[I NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
W1.4o
❑ NA
❑ NE
12128104

G'r M. i b
Type of Visit (2'Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a2 Qq Arrival Time: ® Departure Time: County: CWSt_ ffid Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �� S�� `�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 4 = « Longitude: = o = 4 ❑
Design Current
Swine Capacity Population
Wet Poultry
Design
Capacity
Current
Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
3e40
2otv
10 Non -Layer
❑ Dairy Calf
Dry Poultry
❑ Layers
[I Non-Layers
El Pullets
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Stocker
[IBeef Feeder
[I
ElBeef Brood Co
❑ Turkeys
❑ Turkey Pouets
❑Other
Other
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?
Page I of 3
❑ Yes UNo ❑ NA ❑ NE
El Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
❑ NE
❑ Yes
❑No
[]Yes
]
[]NA
❑ NE
❑ Yes
7No
❑ NA
❑ NE
12128104 Condnued

I
FIcility 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?
f .Structure J1 Structure 2 Structure 3 Structure 4
Identifier: LA&M/"
❑ Yes E �No ❑ NA ❑ NE
El Yes [--]No El NA ONE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 7No
A El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U<O ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
7No
❑ NA
❑ NE
Comments (refer to question #) - Explaen any, YES answers and/or any recottimendatrbns or anf other comments� .
Use�dirawmgs:of facility to,better explain situations (use`Additional pages as necessary)
f
Reviewer/Inspector Name offi/ Phone: 9b 774 '" Sg
Reviewer/Inspector Signature: Date: i Ci
Page 2 of 3 1 12128104 Continued

I
(Facility Number: — (j Date of Inspection 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Mans ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
❑ Yes ET/No ❑ NA ❑ NE
❑ Yes LSNo ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � o El NA [I NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RP
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
v
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
71�to
El NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�,�
L/� 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
q o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L/I No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ,C,00 pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit k Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [__1 Denied Access
Date of Visit: Z 8 Arrival Time: �jj� Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: R Title:
Onsite Representative: 03AM �IQ U E IVT &J
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E:] o [_] ' E�:] « Longitude: 1-1 ° E—] I E__1 ff
Design Current
Swine Capacity Population
❑ an to Finish
Wean to Feeder $ 0 f:rfi
❑ Feeder to Finish
Design Current
Wet Poultry C*opacity Population
❑ Layer
❑ Non -Laver
Design C►urrent
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Feeder
El Farrow to Finish
❑ Non -Layers
❑ Pullets
❑ Gilts
❑ Boars
El Beef Feeder
ElBeef Brood Co
[I Turkeys
Poults
11100ther
OtherHEITurkey
❑ Other
Dumber of Structures:
Discharzes & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
E❑
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
IJ No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
I2/2"4
Continued

Facility Number: Date of Inspection 23 0
R•aste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2 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: LACr-v A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1&o ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes�No
'N/ ❑ NA ❑ 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 otherthan the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L►'.I No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CJ 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 Drifl ❑ 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
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
pia
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
❑ NA
ElNE
IT Does the facility lack adequate acreage for land application?
ElYes
�Jcp
❑ NA
❑ NE
18. 1s there a lack of properly operating waste application equipment?
❑ Yes
bZo
❑ 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):
i
_
�
p
Reviewer/Inspector Name Phone: �� - 3 7
Reviewer/Inspector Signature: Date: 2 oQ
i 12128104 Continued

Facility Number: 6'j — Date of Inspection �.
Required Records _& Documents �,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Ed Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box. ❑ WIJP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
[allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
VNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
El No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
LXNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
OrNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B 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
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewhnspection with an on -site representative?
❑ Yes
�A
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
� Co
❑ NA
NE
Comments and/or Drawings:
12128104

.A
Division of Water Quality
Facility NumberDivision of Soil and Water C ateonservation
' Q Other Agency
E
o€Visit pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
on for Visit Routine O Complaint O Foilow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 0_0 Departure Time: County: FNS L4 lam/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: BA26p
Certified Operator:
Back-up Operator:
Location of Farm:
S GOTO IJ
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =' Longitude: = ° ❑ � ❑ «
Design Current
Swine Capacity Population
Wet Poultry
Design
C►apacity
C►urrent
Population
C*attle
Design
Capacity
Current
Population
❑ Wean to Finish I
❑ Layer
❑ Dairy Cow.
® Wean to Feeder S $`{O p
1 10 Non -Layer I
I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Dry Poultry
El Layers
❑ Non -Layers
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
El Pullets
El Boars
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Pouets
Other
Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes <o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
tYJ No
❑ NA
❑ NE
❑ Yes
'- 14O
❑ NA
❑ NE
12128104 Continued

FacilitytNumber: 7 — (G Date of Inspection dS o
4ie Collection & Treatment
�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes 12 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 F4o
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 2fNo
❑ 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
[]�o
❑ NA
El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[I Yes
'
❑ NA
[I NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
7No
9. Does any part of the waste management system other than the waste structures require
[I Yes
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�(TNo
❑ NA
❑ NE
maintenance/improvement?
VNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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 dNNo ❑ NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes LJ 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? ❑ Yes El El NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary)
FC5 r_UC CV E.k-9 PAS IZESE� j 1i�1 h t.0
7-tu'r G.. O , �
WWSTC S0 APPiZCh To PAN. .Sl4ot
I'3(,. -ro S G o . r546Z, APP OW PA d CZTh 0Z_ w�Q `l�, geA y%AJpA
je+tios 9130
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Pate 2 of
Phone: D 11.6 Date: 'L 1-7-3 I 1
n'
12128104

c
Facility Number: — p Date of Inspection
Riguired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[(No
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Doe record keeping need improvement? If yes, check the appropriate box below.
Yes
El No
❑ NA
El NE
aste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�fNo
u No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L/I No
❑�NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
r
El
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[INA
ElNE
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?
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
0/11
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElFNVNo
El
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

0
I'
Facility Number
0 Division of Water'Quality
0 Division of Soii'and,Water Conservation /.
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance V Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ILtd.L J Departure Time: County: dA/QdmJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 16A1�1 i M IUAjrom
Certified Operator:
Back-up Operator:
Location of Farm:
Design
a Swine Capacity:
:. -
❑ Wean to Finish
® Wean to Feeder b
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Title:
Latitude: n e
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
«
<
Longitude: F] 0
0
Current Design Current Design "
Dpulation Wet Poultry ,;. CapacityPopplation;: Cattle : Capacity P
LJ Gilts
i
❑ Boars
Other
❑ Other _ -
] Layer ❑ Dairy Cow _
] Non -Layer ! ❑ Dairy Calf
_ �__,
❑ Dairy Heifer
Dry Poultry El D Cow
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeX Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures,,,.0
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 9 o ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N ElNA
[3NE
❑ Yes
❑ Yes
L=J [I NA
El NE
[I Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: 4- Date of Inspection til Ois
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 l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 146E�at'.)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): go
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes $No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 54 ❑ 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
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
,ffNo
LG 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 ElYes
2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
n 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 ElEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) r6sc. uE L14l 8(9) S(jr (�
13. Soil type(s) RA ZWT
14. Do the receiving crops differ from those designated in the CAWMP?
❑ es
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
I Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
.Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary.):
1S) Gour1Nu6 w t 6-0 Lpil)t_" ►, MC&a ro e-irr 560 A&AZAA
`
Reviewer/Inspector Name l.V — --� Phone /D G -7.2 (pig
Reviewer/Inspector Signature: Date: -r-& 6
Page 2 of 3 12128104 Continued

r
Facility Number: — Date of Inspection 4 tNo
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes El
El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design [3 Maps El Other
21.
Does record keeping need improvement? If es, check the appropriate box below.
p g p Y
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1&
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
[3NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[3'*No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EJ/No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P4A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L7 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
0 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?
ElYes
O No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ENo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visitpiiance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit 7Routine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of visit: 3 3a 0 Arrival Time: Departure Time: County: CW49-014 - Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: lJpaSirat. P, r rysrJ &gL& Mli A( VRII%Integrator:
Phone No:
Certified Operator: k_.*>MF=0A61 5 t,'J_�€.MfJ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = 4 ❑ 6 = Longitude: ❑ ° ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
38 4o a- l v ❑ Non -La er
❑ Wean to Finish
® Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
El Dairy Cow
❑ DairyCalf
ElDai Heifer
El Dry Cow
❑ Non -Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
12128104 Continued

Facility, Number: & ? - Date of Inspection 30 o S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2(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: CA600AJ I
Spillway?:
Designed Freeboard (in): ZA
Observed Freeboard (in): so
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E6No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
_,(
EI 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
0"No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2rNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
eNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) R &CV E LM l QEn.rnv C H) 5 Clo
13. Soil type(s) RqL't r s s
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L�No El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes LJ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes [2' qo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes VNo
El NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
x- -
IVM
Commerets {refer to gaestion #): 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}:
C."Le C>C5a1e
1�yS d� OCT. 1,00', N►AAKC T00-C Ta Tr•A1IJSfEg- REGoc-I Tb NEGJ PULrA7Z ' �fZ•Ih5
J NE;Co r, ±jI A t~ re:lL
Reviewer/Inspector Name U E q x � o . Phone: (7t ) :7qs 3 5 D�� ZA3
ReviewerlInspector Signature: Date: 3130/o S
IZi-161v4 Conanueu

Facility Number: ("� — J o
Date of inspection I IMtO-S'
Aeguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
2<
ElNA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
ZYes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 9<onthly and I"
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Dof o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑'Na
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
El No
_❑lNNA
NN
[/JA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
No
E..,,
A
[I NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
E❑
LET.❑
NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
LAVA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes go ❑ 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
e No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2 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
D o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2!j'No
❑ NA
❑ NE
Additional.Comments and/or Drawings:
12128104

Type of Visit C.,00mpliance Inspection O Operation Review Q Lagoon Evaluation
R Reason for Visit Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Bate of Visit: 3/ Time: �r
Facility Number Q
O Not Operational O Below Threshold
jd Permitted 0 Certified © ConditionalllCjertified © Registered Date Last Operated or Above Threshold.
Farm Name: ....._ .C. .......`` .._._ --- ,. _._ County: _» ...�NS....... .. ..� ».... » .
�`fA�2Q� 0T7
Owner Name: ...................................... ............................................... Phone No: ........................................... ..................................
Ylailmg Address:
Facility Contact: ............................................... *-*-............ Title:..
Onsite Representative:..�1d?�,�,r
Certified Operator: ...................... ....... I ......... . . .. . . .
Location of Farm:
No:
8 Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' " Longitude • ' "
Deagtt 'Current �` Design Ciurent' Design Current
Sw%iiQe_ _ JCa 8 Poeation
.P bid- ` aci r a
C n Po"'iilat,an Cattlle ~ act `Po`ulaho
m
We to Feeder $
; ❑Layer Dairy
Feeder to Finish
_ ❑ Non -Layer ❑Non -Dairy
Farrow to Wean
Other
El Farrow to Feeder
Farrow to Finish
TOtal Design Ca P aCrty
❑ Gilts
Y � 3
Boars
- Total=SSLW
Discharves & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 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
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. __ .._ ..___.. __.._ ..... _,. ............._.. _ __ . - ....... _...........................
Freeboard (inches): 3 Z
12112103 Continued

71
JFact 6 Number:
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 maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes )"No
❑ Yes XNo
❑ Yes /No
❑ Yes ONo
❑ Yes /"No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Z No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ING
❑ Excessive Ponding ❑ PAN ❑ H draulic Overload ❑ Frozen Groun ❑ Copper and/or 'nc
12. Crop type n t± �. 0 oj!Z 5_r4
13. Do the receiving crops differ with those de ignated in the Certified Animal atte Management Plan (CAWMP)? ❑ Yes )No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes )ZNO
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 gNo
16. Is there a lack of adequate waste application equipment? ❑ Yes JXNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [:]Yes gNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes WNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes gNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ YeslZNo
Air Quality representative immediately.
Comments {refer to:gaestiob- Explatn_any, YFS:answers and/or any recommendations or any other, oom>aents. ® _
_ _-. _
Use dratobetter explmn sies ❑Fie ld Copy ❑Final Noies ^
_ -
-. ;rf
• -.�_ � . ' __ �� aye-- - �
FITTOW'ib"O' 6?*4c. v eRmrro,¢ 141f �o S��c G� Dv,� �
R��
A.
fX6t� LtJi35 /�o uJ p p &) 4-5 4ArITEO
05 „� o %,0s trfO �N , I.cJAS Tf 14"6 z['�-r�onl
7vcr�TF,o -7o_w ^,q i,.e v eem u0m,
f
A
�0_5
AA) AAA 1`�
4en ott
Oa_,
OA-lrw r PU,)Q.
7
Reviewergmpector Name
Reviewer/Inspector Signature: Date:
12112103 Continued

N.
Facility Number: Date of Inspection DZIAV
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ONo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ W13P, checklists, design, maps, etc.) ❑ Yes PNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONo
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
;ZNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
ly es
ElNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
XNo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit oCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number /Q Date of Visit: I O� Time:
Not Operational OBelowThreshold
E3Permitted E3 Certified r[3Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: ` c-J e. County: 0 ^ / Q �
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title:. Phone No:
�Y" 11
1� G4b re
Onsite Representative: G e ° '^ Q -5-ce . ce" se r,V lor.1 Integrator: ee, ✓ 5, 4 11 O t"Ja °ot
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 06 0" Longitude 0a 0° Du
Dischar& Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ,❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection &"Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ,ZNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

t
Facility Number: (o?
Date of Inspection ( p
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Apnlication
10. Are there any buffers that need maintenance/improvement?
It, Is there evidence of over application? / [I Excessive Ponding ' PAN El Hydraulic Overload
12. Crop type Fe S c. u e . [, a r vl I/J yea 4 s
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Recgrds & 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?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ZNo
❑ Yes ETNo
❑ Yes ONo
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ETNo
�SYes ❑ No
❑ Yes ErNo
❑ Yes ❑ No
Cl Yes ❑ No
❑ Yes ❑ No
❑ Yes 12rNo
Cl Yes ONO
❑ Yes ❑ No
❑ Yes .rNo
0Yes ❑ No
❑ Yes ONo
❑ Yes ,TNo
10'y'es ❑ No
❑ Yes _,O'No
❑ Yes ❑ No
❑ Yes 12rNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to: question Ezplainany YES answers and/or any tt recommendaons or any'other comments .;
Xsel.rawingsroi facility to tietterjexplain sihiahons ^{use additional pages, as�necessary) �; ❑Field Copy ❑ Final Notes t
!q . Free boa rof leeoeOU I I'e '10tie ►1) k-ejoq t-vee jl� . 1Vee'e( 4,0 kpa�
ee,ba i -d reeerd! &ueekl
�
Wee d 4o be sv,, e 4o ket ve A w&Y4e R ►Au 1 y s; s da4ed w;*i i, ., 4
o(�ys o P ap f 1; c A4iein events; 4kere it nn waAe, Ann 1 ySis �a}ed w'44,;,t.
4cLVi eP ScP4. 2) 18, 41r3/ ZOoI e-veyfS. JT t,c C 1 —f-SA one I1 ScJ a�B
nAed -J-vr.c. 2a -1, Dee q Z o01 . q 1.so, need 4o be sure 4o ure q (coYH)
H.,
1
Reviewer/Inspector Name Orl.ct%e7R It .
Reviewer/Inspector Signature: Date: S' (a 4 L
05103101 Continued

Facility Number: (o — / O] Mate 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 property within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan btade(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 ,[ErNo
❑ Yes ZNo
❑ Yes dNo
❑ Yes Y No
❑ Yes Z'No
❑ Yes ❑ No
lg.(4anIPn-,eci--) we,j4e e)v,,"17s,s e4n4ccl w64dcvy-ser-Ike.
G l)-cA4iej, evcy4r �p Grt%G U Ic4e, 4 �g n7Vr-O-9ey1 �h��iie a�
-/11e =►122- Z. Alf l ; l PG Arpds, need �o re c a I c ✓Iq �e >�'a,/•
a 17'?gfG4 2-01 2-602. F-venq O -t--/e.sCve h., vse 2. Z
q rt A l '� f �J i ►�.S'�cc,� 4 tC � . D �'�- p,., 1 Zl � l p l a Yt �, (ys, s ,
41're 'iced -lo be sire 4o �,,ve ct so;l 4es4 -,re ,ed boy
ece-,Clt r1';)e)d . Tl7e"C is no `2-001 soSl24cS4 re�olV Aar AeleSGve
f; l�lDt W7?i Ie -/Aeve eve feODl�S,-�`o� 7�,C' r'ow Gra�e
ThP r'e��cSc�?>laa��rcS Sai� (/41W1 c, <en�
7 Zoo) .
ll. �l�e�e it 1 bs �q��e ave �a /),Ca4,fO N (_-F PIaH)
I.✓ h,-Ad G ro je o k, FTe ld 4 a¢
Zo,Gret . tVA-f-]c fla" glrro►.f�I f3 Z lhs ?A/i/07ere wit; le
l�s lbs p/�iv�arre -►�e,s oyey l.,�d
1'7 . -T L1e fee IS n e Cer- ,;, , /A) e Of'
ami1A61e -,eel
A'AI been me- Cx ; -7 -AC glje .sa - h d �- 2, Q ar'e
al y, n gr tie er ;4 -fie,e,, d sit --Ael h l e o e
re ee i Wlt 4b,e Z W , V 1o,0,C
2z . DW re�0 o19-:ce .r4oLild hcive bee- Ie4,4';ed of
o vera��p]► rqa >'vLt of P/IXMf PJw',; l ab)e NrlroJcrt
No -le = Tt,e sla,-ay of�o�
Aescve kleed� 40 be hayed[ .Toovn angr
sk&JA.Jd to do�lc Sno�-►• �I.so, �L,e l a5o� ern d g �e� q�or,>rnel
!-,oy 11ntts S -;•r fs well and well ���'n�alned•
05103101

J} l
_r
Division of Water Quahty i
Q'Division of Soil and -_Water Conservation
Q Other., Agency
L
f Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
for Visit woutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: �-0 ( Time: ,Qd Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Permitted [3 Certified © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .••...............
....w
Farm Name: ...`....��.�..:.........4.��}�11:.............................................................. ...... County: .........
Owner Name:
Facility Contact:.............................................................................. Title:
MailingAddress: ..................... ...............................
Onsite Representative..... ............................ ........... ........
CertifiedOperator:...................................................................
Location 'of Farm:
Phone No:
Phone No:
..................................................... ......................... ................. I........
integrator:...... ...........:............... ................: r......._.........
Operator Certification Number: ..........................................
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude ' A 66 Longitude ' 6 &4
Design Current
Canacity Ponulation
Wean to Feeder
$ U
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design - Curent Design Current
Poultry Capacity'..population Cattle -- P tion ,
❑ Layer ❑Dairy
❑ Non -Layer ❑ Nan -Dairy
❑ Other
Total Design Capacity,
Total SSLW .
Ntontber,of Lagoons ❑ Subsurface Drains Present ❑ Lag+w►n Area ❑ Spray Field Area
Halding.Ponds / Solid Traps ,: ❑ No Liquid Waste Management System
DischaMSs & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..................................................................
Freeboard (inches): 3 6
5/00
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes kallo
❑ Yes 1xNo
Structure 6
Continued on back

►f �.. 41
Facility Number: - 16 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [�<No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 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 Z No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes '$�'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes O`No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �:fNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes MNo
12. Crop type '--t , C(L-Jisu
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JgNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
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
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available? 14Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes P No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) M'Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONO
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes )4 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 j WNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 0 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )R'No
�'Vo yialaiit. s .o. def ciendL,s were hated- dufing this'visit, • Y:oi� WRI -teceiye dd fuirther - '
correspondence. ahatit this visit.
Cori€tments (refer to. question #):.Explain any YES answers and/or any recommendations orany other comments_- ` _
Use.drawings of facility to better explain situations: (use _additional pa
g
e
s as necessary)
\ g _ fit.-.�.,� .� � ��, � t�--. V�
Reviewer/Inspector Name.
Reviewer/Inspector Signature: __ _ Date: 7��--Q( S/pp

Facility Number: 4D— �a Date of Inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ONO
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 391No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes &No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes M No
Additional omments am orDrawings: -
Vr L"' w t L
.2�
5100

Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Ci Date of Visit: ®Painted on: 7/21/2000
Q Not Operational Q Below Threshold
© Permitted Cer�ti'fied ©(Conditionally Certified [] Registered Date Last Operated or Above Threshold:
Farm Name: 5ZA t��>�2 County:.... ��\�r!`!.................................................
................ ......................................................I.................
Owner Name:.... ............................................... .. Phone No:
FacilityContact: ............................................. Title:................................................................ Phone No:...................................................
Mailing Address: ............................... . ......................
Onsite Representative:.Ol..r✓'........................................................................... Integrator:..... ... ...... ........ ...........................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..............
Location of Farm:
A.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 •4 Longitude • S �c
Design Current
Design Current Design Current
Swine Ca aci Population
Poultry
Ca aci Population Cattle Population
Wean to Feeder
Layer
❑ Dairy
'Capacity
Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
[[]Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
In No Liquid Waste Management Svstem
Discharges & Stream Impact~
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is ohcrr..cd, :vas the coovcyance rnan-made''
b. V discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. ll'discharge is observed. what is the estimated Ilow 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
❑ Yes X No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
kNo
❑ Yes
C�No
XYes ❑ No
Structure 6
Identifier:
Freeboard (inches):
5100
Continued on back

Facility Number:( — iQ Date of Inspection Printed on: 7/21/2000
e
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes h�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 qNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T Do any of the structures need maintenancc/improvement?
❑ Yes
b�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
C Oo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
gNo
Waste Application
10. Are there any buffers that need maintenance/improvement'?
❑ Yes
�ffNo
IL Is there eviden e of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
JWNo
12_ Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
,Yes
[]'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
D '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
❑ No
16_ Is there a lack of adequate waste application equipment?
❑ Yes
allo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
LXNo
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 0 No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes �fNo
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 VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes (d No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes VNo
24. Does facility require a follow-up visit by same agency? ❑ Yes allo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0 No
0:Ro-iolatidiis:ofcences-*irad. dkhthis;visit:-Yoir:wll-cec6viio furtherei
roriespondece'aboit this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
P 5 g►�- y
Y
Ir.0
IV
Reviewer/Inspector Name
!a 39 S 37 Go X-
Reviewer/Inspector Signature: Date: `� G — GG 5100

Facility Number: — Date of Inspection �� Qa 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 atfor holow ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes P� No
❑ Yes �No
❑ Yes T No
❑ Yes No
ElYes No
❑ Yes gNo
he -as \:;'x,�- 2 ,Lac e c, w � �
c�
AL,,,7A (jz��A V . 7� vsaz&,eA rn e� ��V cLzVQ1,_
A
ov-Q-�` I �
+ 'IL--\ 3A
5100

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 6
Farm Name: e_ S
On -Site Representative: 6�e—G-:Se_
InspectorlReviewer's Name:
Date of site visit: O-
Date of most recent WUP:
Annual farm PAN deficit: '� I pounds
Operation is flagged for a wettable
acre determination due to failure of
` Part H eligibility items) Ft F2 F3 F4
✓ Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 49
Operation pended for wettable acre
determination based on P7 P2 P3
Irrigation System(s) -circle hard -hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system 9Wpermanent pipe; 5. stationary sprinkler system wlportable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part 1 exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational table in Part III).
PART 11. 75% Rule .Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required.because.operation fails one of the eligibility
requirements listed below:
_ F1 Lack ofacreagewhichresultedinwer-applicationmfwastewater_(PAN) on:spray.
fields) accordingfofarm'sdasttwoyearsiofirrigation-xecords
F2 UnclearjIlegible,-or lack of informationfmap.
F3 Obvious-field-limitations(numerousiiitches,failure3o:deductrequired
bufferlsetbackmcreage;mr25%:oftotal -acreageadentif edin-CAWMP.1ncludes
small ;-irregulady-shaped .fields --field s-less-than-5-acresfortravelers-or-1essthan
2 acres -for -stationary sprinklers).
F4 WA determination required because CAWMP credits feld(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part Ill .

Revised April 20, 1999
Facility Number
Part III. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP FIELD I COMMENTS3
NUMBER NUMBER'S IRRIGATION ACRES ACRES %
SYSTEM
3
l 3,6`f
1,9
��,q
S
F_
I
FIELD NUMBER' - hydrant, pull, zone, or -point numbers may be used in place of field numbers depending on CAVVMP
and type of irrigation system.- If pulls, etc. cross more -than one field, inspectorlreviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination_
FIELD NUMBER - must be dearly delineated on map.
COMMENTS' - back-up fields with CAWMP acreage_exceeding475% of its total -acres and having received less than 50%
of its annual PAN as documented in the farm's previous -two years' ( 997 & 1998) of irrigation Tecords,-cannot serve -as the
sole basis for requiring a WA Determinabon_-hack-upfields -must,be�ted in the -comment secton End must be accessible
by irrigatton system.
Part IV. Pending WA Determinations, -
Pi
P2
Plan :lacks. following-informatiom.
Plan revision may_satisfy75% rule based on adequate overall PAN deficit -and by
adjusting'all field acreage,to below 75% use rate
P3 Other (ielin process of installing new irrigation system):

D Division of Soil, and Water "Conservation - Operation Review
,y D.Division of Soil and, Watekonservation`- Compliance Inspection."
Division of Water Quality .Compliance Iinspection
Other Agency. Operatior Review--
J!R Routine 0 Complaint 0 Follow -tip of DWQ inspection 0 Follow-up of DSWC review Q Other
Facility Number Date of Inspection Q
Time of Inspection E=24 hr. (hh:mm)
0 Permitted Certified Q Conditionally Certified © Registered JE3 Not O erational Date Last Operated:
..........................
s QED ......................
Farm Name: ...�........................................................... County :.......
....
Owner Name:.... ........................ . Phone No: .............................. ...
FacilityContact: .............................................................................. Title: ............................................. ................... Phone No:
MailingAddress: ........................................... ....................
Onsite Representative:
......................................................'{� r .....`
Certified Operator:
Location of Farm:
................................................................ .....
Integrator:...... ............................
........... Operator Certification Number:
r................................................................................................................................................................................................................. .... ..................................................... .
Latitude �.�0 �ai Longitude • ° «
Swine,
fyr
Design Current. - Design ' Current _ Design Current _
Capacity Population Poultry_ Capacity Population Cattle Capacity Population w
Wean to Feeder
3 Q
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Nnmber:of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Solid Traps i-HoldifiPonds No Lquid 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 cif the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
❑ Yes 'ONo
❑ Yes ❑ No
❑ Yes ❑ No
d. Does discharge bypass a lagoon system? Of yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [N,'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes VNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..........r`' .................................................................... .....
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes OdNo
seepage, etc.)
3/23/99 Continued on back

Faciiitx Number: = — T Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidenci�,of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes 9 No
❑ Yes 0 No
❑ Yes Nf No
❑ Yes �Oo
❑ Yes 0 No
❑ Yes [M No
❑ Yes U No
❑ Yes I No
❑ Yes [gNo
❑ Yes C$�No
❑ Yes ONo
❑ Yes 9No
❑ Yes b(No
❑ Yes XNo
❑ Yes a No
❑ Yes [�(No
❑ Yes KNo
❑ Yes 4 No
❑ Yes RNo
❑ Yes 9No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
o violaiigns'or def cie Chas vier@ itoteci iiirt......visit... ....receive;. further
correspondence. A6wf th' visit.
Comments,(refer to question #) 'Explain any YES answers and/or -any recommendations or any other comments
Use:drawings of facility to better explatn.situations {use"additional pages, as necessary)
Reviewer/inspector Name
ram-
Reviewer/Inspector Signature:
Date: C; — _C)V—aq _ I
3/23199

l aciliV Number. — Date of Inspection �C]� ja�q
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
NNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
VNo
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
M
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
P'No
A:dditional Comments and/or rawingsc:
3/23/99

,i NNI-E iloliz�iffl E3 Division of Soil and Water Conservation 13 Other Agency
Division of Water Quality
10Routine OComblaint 0 Follow-up of DWQ inspection 0 Follow-up of review 00ther I
Date of inspection it)
Facility Number
Time of Inspection p. 4 6 24 hr. (hh:mm)
[3 Registered 13 Certified [3 Applied for Permit E3 Permitted 113 Not Opera Date Last Operated: ..........................
FarmName: ...... 5.c..C.rm .......... Fmzm .............................................................. . Countv: ......... P.65G 16J ........................................
Owner NameQ 5�q.....--..5..7.z. Phone No: .�./O ...3.Y..7
... :.........-
...............
........
11 _397AV.34..
Facility Contact: 3ARW .. A ..... 13C—NT ... Title: ........C . ...................................... Phone No: .
Mading A . .............
Addres' s:
vc ZF jV/
...... .. .... ... ................................. . ........................................... ........ GW ......
Onsite Representative:...... ...... B.jgQ�..................................... Integrator:...... ..............................................
Certified Operator . ........ F49 ARA N.;.6419�....................................... Operator Certification Number, .... /6-77­9­1 ..............
Location of Farm:
C
Latitude Longitude
�g Design Current Design Current D CurrentScene , .1 F�!gn...
a Cattle, :Capacityftpulation Poultry ".;Capacity Population P6
y _...,of..Capaetty,� pa. fiolk,
Wean to Feeder
-3,9!�o
3300
❑ Feeder to Finish'
0 Farrow to Wean
El Farrow to Feeder
0 Farrow to Finish
❑ Gilts
❑ Boars
General
L Are there any buffers that need maintenancelimprovement? ❑ Yes No
2. Is any discharge *observed from any part of the operation? 0 Yes VNo
Discharge originated at: 0 Lagoon' [I Spray Field 0 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 lagoonstholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Pid the facility fail to have a certified operator in responsible charge?
7/25/97
C1 Yes [I No
El Yes 0 No
• Yes
El No
• Yes
JXNo
• Yes
(Po
El Yes
0 No
[3 Yes
0 No
Kyes
0 No
Continued on back

]Facility Number: —
10
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes J&No
Structures (Lag_oons.Ilolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ElYes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure. 5 Structure 6
Identifier:
Freeboard(ft): '.......................................................................
I0. Is seepage observed from any of the structures? C}. Yes No
1 1. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes *o
12. Do any of the structures need maintenance/improvement? ❑ Yes PrNo
(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 WN0
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 DW )
CCO,ea
15. Crop type k��T:.`..eSCGeFsIXt_....���!!�7..C.gP...,�11Si2r!STT✓....-..G.aCr¢ru?..r?y!s.�14�7
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes MN
I7. Does the facility have a lack of adequate acreage for land application? ❑ Yes KNo
18. Does the receiving crop need improvement? OYes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes IN:,No
20. Does facility require a follow-up visit by same agency? ❑ Yes gNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes GXN'0
22. Does record keeping need improvement? ❑ Yes [ No
For Certified or Permitted Facilities_Q"l
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes CO No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes �1 No
O"NO.Viola"tions" or deficiencies were -noted during this.visit.- You.will receive no further
correspondence about this visit:•: - .' • ....
imtnenf (refer.to question #): '_Explain any YES answers and/or any reconimendatuons;or any,other comme
e.drawungs of'facility to: betterexplain shuations. (use additional pages as necessarv) '
.)PRAY S ITT✓ µ057- gE Q6-AMYZZ) WI7Hin1 THE 8 �
7/25/97
Reviewer/Inspector
Name
r:rJ2�61
Reviewer/Inspector
Signature:
nIc
Date: /�ZZAM

r
x❑ DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspections
1® Routine O Complaint O Follow-up of MV0 inspection O Follow-up of DSkVC review O Other
Date of Inspection %
Facility Number
Time of Inspection ` �3 24 hr. (hh:mm)
[3 Registered 13 Certified Cl Applied for Permit © Permitted [3 Not Operational I Date Last Operated:....,. .
tt 5 i Countv: ( L!-'S. � trcJ
Farm Name. .:............................ . D...._......�....t!.l- -
.............................................:................................
n,� 7
Owner Name:............ tpv;? r.................... 1- ....................................... Phone ,No: ....... :7. ..... ,.... z ...........
Facility Contact: L. Title � ......... Phone No: ....., ^
f�cd 7�
Mailing Address:... ..D........... .!'^S fr' P.A.... �r rS.c��!{ v. .�,e5r.........................
Onsite Representative:. ��: 1% R"............ _�1 ....................... Integrator:.....1 . S%..�r.?!....................._................:...
Certified Operator;..:{,i?.($.i�/-............. -..... 3�'-?��!.............................. Operator Certification Number;..J.......-.....
Location of Farm:
Latitude 0 L 4C Longitude O• O6
Design Current Design Current Design - Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity, Population
PWean to Feeder Lf-0 bO ❑ Layer ❑ Dairy
Feeder to Finish ❑Nan -Layer ❑ Non -Dairy Farrow to Wean Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons / Holding Ponds 10 Subsurface Drains Present 1111 Lagoon Area 10 Spray Field Area .:.
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes [ -No
2. Is any discharge observed from any part of the operation? ❑ Yes [9-No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, wa:< the conveyance man-made' ❑ Yes G No
b. If dischar�g is observed. did it reach Surface W'Mer? (If yes. notify DWQ) ❑ Yes [r -Mo
c. If discharge is observed, what is the estimated flow in galf nin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
B'No
1 Is there evidence of past discharge from any part of the operation?
❑ Yes
[9<0
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
RNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
[ -No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of desityn'? .4V9// ?
[]'Wes
El No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
fi No
7/25/97
Continued on back

Facility Number — O
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoons,floldinj! Ponds, Flush Pits, eta
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ........
10. Is seepage observed from any of the structures?
I Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes [Iio
❑ Yes UNo
Structure 5 Structure 6
❑ Yes [moo
❑ Yes 53-No
12.
Do any of the structures need maintenance/improvement?
931y'es
❑ 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
RNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
fig -No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type . i'£.�7.�:v. �- :...................---............................................... �.5 �? y.. t!!^c5 .... ............. G✓i Efl `- •......................
16'.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
RN
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[ O
18.
Does the receiving crop need improvement?
❑ Yes
0,1�0
19.
Is there a lack of available waste application equipment?
❑ Yes
U"No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
9 1 I/o
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
22.
Does record keeping need improvement?
❑ Yes
h0.<O
L`7 No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes Q'i�10
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes YNo
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes O No
No.violations or deficiencies. were' noted- during' this:visit..You:will receive no ftirther
correspotidence about this:visit: ..
Corti rents (refer to question #);: Explain any YES answer's and/a"many reconumendattons nr any
Use drawings of facility tdbetter explain situations (use additional pages as ieeessary)
Ntf0, Ta Mutd iNNJZIZ- a/Adl� cv4' &I tP-3s1
5v0%4, c Tv wffL H1AJ-1 r� 4A[rem
7/25/97
777
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: D

•
•
•
FolloU' -uk Site Requires Immediate Attention:
Facility No. to l - 1 O
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 9 Z , 1995
Time: 2 : oo PM
Farm Name/Owner. 5c o rrs Hog 1aarrn\ 6-'c ac,E ScA`tT. -
Mailing Address: 5 $o,c -_495 R soaU Ire,. N C _ZSS d ��
County: _ e Sc_o
Integrator- - A e-L)H o F F - - - — - Phone: ' ZSQ - X I I)
33 Lf -7 ` 3 3 ZO co7r's
On Site Representative: '&LuffibkRuS-�rsr. CoNsa�kri��s� Phone: `f55-`fY7Z
Physical Address/Location: rolrew MwY /79 To Pruf4mcr 41bm � a.� i nterse-sk lazy � 04)
t-UP-0 2LghS- -- go .I rv►r IE...+o Jrµ �a&K60- ` UR-KI ��Fr F-OLLOL-1 -Tr .6
jcA �j A vvv
Type of Operation: Swine Poultry Cattle
Design Capacity: 3846 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' 4q _ ' n b Longitude: 77 ° Z 3 r r Elevation: 20 Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or& Was any erosion observed? - Yes or(n
Is adequate land available for spray?(Ye r No Is the cover crop adequate? Yes orE)
Crop(s) being utilized: has -k ",, r n
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings s or No
100 Feet from Wells? 6 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or&o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or V�o
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-made devices? Yes oo If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spec acreage with. cover crop)? Yes or No
Additional Comments: M_
� !� o9 `
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
d DIVISION OF ENVIRONMENTAL MANAGEMENT
. v ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
+11 Time:
/ /d
Farm Name/Owner:_ S C D TC S H 0 C) r1VRM / C, EO(2L, 6:' Ec, 1
r
Mailing Address: R + 5. _I3 ax 4-9 5 JAC.KSotj 11G , /NC aes46
County: PaN 5 LaLZ
Integrator. Ni u v�'�F F Phone: ZA 9 - J-11 f
On Site Representative: no-n -2 �„ y t a�1. G Phone: 3 47 - 3 3 2 0
j I W y i �b YiTZ UM MFTK�+ci JvV� — �f�-r3 �{ �j2i -�--- Tu. -7.
Physical Address/Lpmon l3z S) .St M PftFLKEfL'QD_ to END , TR KE A- LC- FT a AJ
T krr� fi r �•, sQ ` 2AUEL_ P-ID, TAk.6_5 � STI.Ai o To THC F4+p.M isr G `
Type of Operation: Swine V Poultry Cattle
Design Capacity: .38 q0 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 4 q 00 Longitude: -77 ' z 3' �_" Elevation: Z o Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: __�__Ft. 2 Inches
iWas any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for sprays esn_ r No Is the cover crop adequate? Yes o�
Crop(s) being utilized: CC�Ct t�l �-t i �s,.ecQ ` 1i_ rasp✓ Apr f
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellinQs`v or No
100 Feet from Wells? Deor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oCNN
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or IV If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o(f)Additional Comments: \ 0-5�ob-r\ I m �,r• a-e -BP �-o s�
Dal--_A__�
Inspector Name
IKWWWW,41
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

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�NDER:
Vy ample items t and/or 2 for additional services.
m • Co.�tprete items 3, and 4a & b.
I also wish to receive the
w • Print your name and address on the reverse of this form so
m return this Card to yuu.
that we can
fOIIOWIng Services (for an extra
fee):
��
b ''• Attach this form to the front of the mailpiece, or on the bacx if ace
m p
L does not permit.
? . [1 Addressee's Address
m
ccF
r
• Write 'Return Receipt Requested" on the mailpiece below the article number.
• The Return Receipt will show to whom the article was delivered and the date
2. ❑ Restricted Delivery
•"
a(
delivered.
G -
•e Article Addresse o:
CD
Consult postmaster for fee.
4a. Article Nu�m—ber_p
m
0
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b
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0 � �t ✓
4b. Service Type
El Registered ❑ Insured
}
U
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i Certified ❑ COD
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W
X
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❑ Express Mail ❑ Return Receipt for
Merchan{
dise
3 r
7. Date elivery
l F` 5-
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Cr
S. ignature ( ressee)
S. Addressee's Address (Only if requested
I.-
and fee is paid)
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6. Signature gent)
Y
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I
PS Farm 3811, December 199? *U.s. GPO: taxi--as2a,4 DOMESTIC RETURN RECEIPT
(

•a dMv�
State of North Carolina
Department of Environment, Health, and Natural Resources
Wilmington Regional Office
James B. Hunt, Jr. Division of Environmental Management Jonathan B. Howes
Governor Water Quality Section Secretary
Certified Mail # Z405 591 403
Return Receipt Requested
Mr. George Scott
Rt. 5 Box 495
Jacksonville, North Carolina 28540
. Dear Mr. Scott:
•
August 15, 1995
Subject: Scott's Hog Farm
Facility Number 67-10
Onslow County
On August 2, 1995 Staff from the Wilmington Regional Office of the Division of Environmental
Management inspected your animal operation and the lagoon(s) serving this operation. It was observed
that your waste lagoon had insufficient freeboard.
MRCS guidelines for Best Management Practices require a minimum of one foot seven inches of
freeboard. This is based on the amount of storage space needed to contain a 25-year storm event of 24
hours duration.
To remain a deemed permitted facility, all corrective actions must be made within seven (7) days.
Failure to do so may result in the facility losing it's deemed permitted status and being required to obtain
an individual non discharge permit for the facility.
Please be aware it is a violation of North Carolina General Statutes and Rules to discharge
wastewater to the surface waters of the State without a permit and/or to fail to follow a certified waste
management plan. The Division of Environmental Management has the authority to levy a civil penalty
of not more than $10,000 per day per violation.
127 Cardinal Drive Extension, Wilmington, H.C. 28405-3845 0 Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer

George Scott
August 15, 1995
Page 2 .
When the Required corrective actions are complete, lease notify this office in writing at the
� P > P �y g
address below. If you have any questions concerning this matter, please call Pat Durrett or Dave Adkins
at [phone].
Sincerely,
Pat C. Durrett
Wastewater Treatment Plant Consultant
cc: Dave Adkins Regional Water Quality Supervisor
Harry Tyson - County Soil and Water Conservation District
Onslow - County Health Department
Tom Jones - NC Division of Soil and Water Conservation
Operations Branch
E
0

191 aus 3 e l995

OPERATIONS BRANCH - WO Fax:[phone] Jul 24 '95 Ie'v :U7 P. 12/1
Site Requires Immediate Attention_
Facility Number:
SITE VISITATION RECORD
DATE: T & , 1995
Owner: o See Farm Name: ca
County: ef)�-S �2i2e _
Agent Visiting Site: 6&orgo Phone, t0�-
Operator: r e 5 Phone r 3 Z4
On Site Representative: T Phone: _ Physical Address: ,_ 13 25 .�..n a jif 'fIi �
�_ T"Oe head _ _.' �.�
h4_75 _ s& ' K
- - - - T—
ailing Address: _��` ,�• �" �,�L_.�9_�
4.
Type of Operation. Swine Poultry Cattle
Design Capacity: 3 ?9'0 - Number of Animals on Site: • 3SI-6
Latitude: � ---. ° ' . " Longitude: o
Type of Inspection: Ground Aerial
' Circle YC. ()T No
Does the Aninial Waste Lagoon have sufficient flcehoard of I foot + 25 vet v 24 hrnlr Storm event
(;ipproximately I Foot +8 inches) Q �--v or No Actual Freeboard: _ Feet �^ Inches
For facilities with more than one lagoon, please iddvcss the ether Iagoons* freebooLrd under (lie
conimerits section.
Was any seepage observed from the lagoon(s)? Ycs or 4D Was there erosion of the darn?: Ye:s or
Is adequate land available for land application? Y�. or No Is the cover crop adequ-me? or No
Additional Comments:
-411
Fax to [phone] Sign ure of Agen