670011_INSPECTIONS_20171231

NORTH CAROLINA ..�
Department of Environmental Qual

Type of Visit: 0 Co liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Denied Access
Date of Visit: Arrival Time: Departure Time: 3 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: V'e t')A)6 �e x Integrator:
�� Certification Number: _ LAP U U'�"
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design Current
!L0apacity Pop.
Design
C*attle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
11
INon-Layer
I
airy Calf
Feeder to Finish
Farrow to Wean
Design Current
aia Heifer
Dry Cow
Farrow to Feeder
1] , Ploultry
C•_a acit P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I
Turke s
Turke Poults
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2/No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ o
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
Structure , Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWR
/01
7. Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE.
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNog [DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes IN c❑ 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
[y o
❑ 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
Vc
❑ 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
❑ 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
❑ 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 dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield El120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes �VNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: (42'1- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25: Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes eNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 7No
0 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 ❑ NA [D NE
If yes, contact a regional Air Quality representative immediately.
30. Did facility fail Regional Office by the
Yes dNNA NE
the to notify the of emergency situations as required
[] ❑ ❑
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 ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes No ❑ 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 ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility tobeater explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone:01b6 I'
Date: (A'A 6
214/ 01 S

Type of Visit: Q Ca pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ` Z f Arrival Time: Departure Time: % 3 County: OIJ5-(,6 LA) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: K(-_tJAJC-T 8 lA X Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
16 � 6'
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Curren#
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
i'< Wean to Feeder
D 601
iNon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oul_ ,
Layers
Ca PAC
$o ,
Dry Cow
Non-D '
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
dNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
F(No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: jDate of Inspection:
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ZfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA(Vc�o'-)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �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 0N0 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [/(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes e] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [yNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding D. 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 R� No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FfNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
i
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [5] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [fNo ❑ 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 dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [;]"'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: I L O I
�4y Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ / No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ZNo ❑ 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 CalNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ffNo ❑ NA ❑ NE
[—]Yes (]"No ❑ NA ❑ NE
❑ Yes (ZNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
E /No ❑ NA ❑ NE
�No ❑ NA ❑ NE
FZ/No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers "'and/or any additional recommendations ;or;any other cominents.,-
Use drawings of facility, to better explain situations (use additional pages as necessary):
Reviewer/InspectorName: JoHt,
Reviewer/Inspector Signature:
Page 3 of 3
PhonA 13111
Date: i
21JI2014

IType of Visit: (D Co Hance Inspection Q 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: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: V'C'_f x) c IG cmb
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: `` p
Certification Number: 04-p-
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
.Cattle C*apacity Pop.
Dairy Cow
Wean to Feeder
I lNon-Layer
I
Dairy Calf
Feeder to Finish
1] . P,ouI
Design
Ca aci
Current
P,o ,
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
I Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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 VNj/
❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili umber: I- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1, Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): o
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes C5 No ❑ NA ❑ NE
❑ Yes E3/XO ❑ 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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes QIo 0 NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[" No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Fo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ekf4lo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0410
❑ 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
ff N0
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E(N o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D<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 hfo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 10 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes l�J "� ❑ NA ❑ NE
.�
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F3"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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
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
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
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
❑ NA
❑ NE
No
[] NA
❑ NE
ZN
❑ NA
❑ NE
No
NA
NE
❑
❑
l r l '�
❑ NA
❑ NE
[[]
❑ NA
❑ NE
t_ V'�o
❑ 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).
(At-r0 0-A'X&j pNe� p kip 5k-UP&tL QL-McA) AL- FApC-p, 1I�•v2- L1P o1�T
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
d qz -_tl'
Phone: 1{D !� ✓
Date:
2/4/2 Il

(Type of Visit: O Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Vi! Woutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: / 0 1 Departure Time: County: (W 4 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: k c-N10 1 co x Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop. Cattle
ILayer I I Dairy Cow
Design C►urrent
Capacity Pop.
Wean to FeederhwEiNon-Layer
I I
Dairy Calf
Feeder to Finish .
Dairy Heifer
Design e n Dry Cow
D . P,oult , Ca aci P,o P. Non-DaiEy
Layers I Beef Stocker
Non -Layers Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ad ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N ❑NA ❑NE
❑ Yes [yNo
C] NA ❑ NE
[] Yes ❑ NA ❑ NE
Page I of 3 21412011 Condnued

Facility Number: Z2- Date of Inspection:AW
Waste Collection & Treatment
4. I-s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ 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: L tYJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
t L 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Zo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Zo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes .No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A 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 n o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: G-I I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. Yes ❑ No ❑ NA ❑ NE
257Is the facility out of compliance with permit conditions related to sludge? If yes, check E I es ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
�T
❑ NA
❑ NE
Other Issues
�/No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ 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
ZNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ZNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[n/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
dNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ 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).
-
rfle
�) 5 d�
GNP
Y'aw Ntt'J96,0,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Cf� 75?d
Date:
2141201

,1
Type of Visit: ('Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: 7outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 9 t Arrival Time: Ob Departure Time:County: pjuft,n�,j Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: N/►��. j Wx Integrator: Q
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
I
Design Current
Wet Poultry Capacity Pop.
11-ayer I
Design Current
Cattle C*apacity Pop.
I Dairy Cow
Wean to Feeder
I
INon-Layer
I
EE]
Dairy Calf
Feeder to Finish
Farrow to Wean
Design Current
D ,, P1ouI -a aci P,oaci P,o ,
La ers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes FNo
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection:
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): --S]
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes �No[:j ❑ NE
❑ Yes eNNo ❑ 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 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Rio ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes QN ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? []Yes VNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P�Iqo_ ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[JW�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
❑'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑,No
❑ NA
❑ NE
the appropriate box.
❑WUP El 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 �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E34o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑YesrNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -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 Noo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes lao ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ONo ❑ 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 Rio ❑ 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
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 E3No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes [f]"'No ❑ NA ❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesFj'<po ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes El'*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: CIA 09r
Date:
2/4/2011

Facillty,Natnter 0�
�- Division of Water Quahty"`�
0 Division of Soil and Water Conservation
'O:Other;Agency: '
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Q_ /Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 17 Arrival Time: (d b Departure Time: County: UPILdW" Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: C-0- Integrator•
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ i Longitude: ❑ 0 0 , ❑
is
» Design .Current Design Current `. '< Design Current
Swine Capacity Population Populahon : Cttle » a` p ity- Population
C
t Poultry apacjtya
El Wean to Finish" ❑ Layer ❑ Dairy Cow
Wean to Feeder 1 3 $Ltb " JEI Non -Layer I I ❑ Dairy Calf
.
❑ Feeder to Finish
❑Dairy Heifer
❑ Farrow to Wean
a El Dry Cow
`Dry�Poultryj t"
.;
❑Farrow to Feeder
4At: Z'. «�� - El Non -Dairy
❑ Farrow to Finish
ElLa ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets ❑ Beef Brood Cowl
-
= ❑ Turkeys
Othei = Turkey Poults"'.`
❑ Other
On Other I NumbeStructures
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 D WQ)
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 Q No ❑ NA ❑ NE
❑Yes
❑No
❑NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
[I NE
❑Yes
El No
Cl Yes
VNo
El NA
El NE
El Yes
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: (o — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1' A(,�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a.(0
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 property addressed and/or managed
through a waste management or closure plan?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
El Yes YJNo El NA [I NE
❑ Yes CYNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltheat, 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 LI No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes fJ/ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ NA
❑ NE
,El"NNo
LdNo
❑ NA
❑ NE
[. o
❑ NA
❑ NE
El NA
❑NE
El No
❑NA
[3 NE
Comments (refer to question'#}: Explaidaiiy YES answers and/or any recommendations or anv other comment
use, -drawings of facitiit� to better explain situations. (use additional pa
gesas necessary
L oC w-V Lk nC-fL S Luv 6*_ 5 AVc Y �.,�cT _5F e CAN�or F-�,.� 0 `
S u1 o CrF 5 t/yxx -r . �OGf­ PLAW fa Ads ►1q TE .
S gLs,wkc. A -READY RMT p4s t-rj ComF $ACC,
Reviewer/Inspector NameQ1yr Wit, Phone:
_7
Reviewer/Inspector Signature:
Page 2 of 3
Date: oZ
12128104 Continued

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

7 M. it
Type of Visit 6Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 44outine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 5 10 Arrival Time: Departure Time: County: �� N- Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �CLN Gb4
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = = Longitude:
IDesign Current Design C►urrent Design Current
Swine Capacity Population Wet Poultry C►apcity Population Cattle C•apaeity Populafton
❑ Wean to Finish
ID Layer I
I
❑ Dairy Cow
Wean to Feeder I INO 017145
ID Non -Layer I
I
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Feeder to Finish
Dray Poultry
❑ La era
❑ Non-ts era
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Gilts
El Beef Stocker
El Beef Feeder
El Beef Brood Co
Number of Structures:
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Boars
Other
❑ Other
Discharges & 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
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
y
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: (AGi�UA)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ieI 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 ko ❑ NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ENo (DNA ❑ NE
❑ Yes [;3No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E�rNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O 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 El Yes 2 No ❑ 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?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes QTo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
IJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
D No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
B No
❑ NA
❑ NE
Comments refer to question # : Explain an Y>JS answers and/or an recommendations.oran ether conimentsa {
( q } P Y Y y
Use drawings of facility to better explain situations. (use additional pages as necessary) Y �; ��
Reviewer/inspector Name d` Phone: q Ib) 345
Reviewer/inspector Signature: aQ� Date: S n
1�iLoivS� �,uniinueu

,Facility Number: (r 1 — Date of Inspection 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O/No ❑ NA ❑ NE
the appropriate box.
❑ WUP [I Checklists ❑Design El Maps ❑ Other
21.
Does record keeping need improvement? If es, check the appropriate box below.
P g P Y
❑ Yes
�o
❑ 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
C�o
❑ 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
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[P(No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2/No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
0Z
❑ 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
L3 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 YesWN
,_,%
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
o
❑ NA
❑ NE
12178104

Type of Visit Q�pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit. EWArrival Time: Departure Time: County: 0�5 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address: _
Physical Address: _
Facility Contact: Title: Phone No:
Onsite Representative: 1<(Ntj(rr i Coe- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o = = Longitude: =
T1
Design Current Design Cugrent Design
Swine Capacity Population Wet Poultry Capacity Popnlation Cattle Capacity
Current
Population
❑ Wean to Finish
IEJ Layer I
Dairy Cow
Wean to Feeder
$ Q
rd2l
❑ Non -La er
❑ Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Pou Dry ltry [ID Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Feeder
❑ Gilts
❑ Pullets
❑ Beef Brood Co
❑ Boars
Other
❑ Other
❑ Turkeys
❑ Turkey Poults
ID Other
fJurn a of Structures:
Discharges & 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
El NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
El Yes
,❑rN9
U
El NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
I�
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structurei Structure 2 Structure 3
Identifier: _( A&M24)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [JNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ENo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Id No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes In No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
ZN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
9 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
L
er/inspector Name p AJ A&< � Phone:er/Inspector Signature: Date:
rage L Of 3 lb/Lo/VY a,uneanueu

❑ Yes 2 No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Facility Number: (p j — Date of Inspection
r
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 ❑ Desi gn [I Mans El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZIN 0
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
z1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E/io
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Wyes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CO/No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(!, 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
El Yes
,�
L`J No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
�o
El
El
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA
NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�Zo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 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: Arrival Time: Qlj Departure Time: County: aMIl Aii✓ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: k-c- rio ETH COX -
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o= i 0 Longitude: = o= 6 0
it
Design Current Design Current
Current
Swine C*opacity Population Wet Poultry Capacity Population
CattleElDesigr
apacity
Population
❑ Wean to Finish
❑ La er
❑ DairyCow
Wean to Feeder
$`4�j
❑Non -La er
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
Gilts ❑ Non -Layers
❑Beef Feeder
❑ Pullets
HO Boars
❑ Beef Brood Co
❑ Turkeys
Ot] urkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LQ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 ' 12128104 Continued

FAf ility Number: 4 7 — Date of Inspection 4 2�
ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA &OU-10
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 24
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th7eat, 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 G3 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ,❑ NE
maintenance or improvement?
Waste Aylication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 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
Ea
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
2 o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P Z
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6 No
❑ NA
❑ NE
Reviewer/Inspector Name a An W(-6" 1 Phone: 41o7) 7,? C " 73V
Reviewer/inspector Signature: Date: ZR Ar

l acility Number: &77_Ll Date of Inspection w
11
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ICJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
8 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
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
<
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
FNo
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C 3'�NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[IB Yes
,—,,�
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ETNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
ETNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes:No
❑ NA
❑ NE
Additional Comments audlor Drawings:' ..
Page 3 of 3 12128104

' Division of Water Quality
Facility Number �p'�2—Z
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Corppliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0_/Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: b7 Arrival Time: Departure Time: County: JAL i kA Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: ,/ Title: Phone No:
Onsite Representative: lGCNdre-ro 6/v Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design
Capacity I
❑ Wean to Finish
® Wean to Feeder
3 9LJO
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
_„ ❑Other
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 1--] 1 = u Longitude: [= ° = 4 = 4f
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
.ILJ Beef Feeder I I
Number:bf Structures
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
❑ NE
El Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 4:-? — Date of Inspection 26 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes i_J No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: %I 6 o e,'J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 27
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
9_/1 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
,--,�
la 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 notify DWQ
threat,
7. Do any of the structures need maintenance or improvement? ❑ Yes
ICJ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
LJ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
,�
LI No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ONo
❑ 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,D'/NNo
DNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;T`No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&Ko'
❑ 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):
Swa, ( fiver 1/E Y 06 NE w-r
Goly 70 pi-I6) -
Reviewer/Inspector Name r ,1_4 L- Phone vb 7 Y4
Reviewer/Inspector Signature: Date:
Pao- 2 of 7 12/28/flQ C onhinued

,1 Facility Number: Date of Inspection Zo
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ 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 Inspection�No
Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
U3"No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
& o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�Io
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
Cjf4o
❑ 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
[�io
❑ 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
[3"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
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
7No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

I/
r�
Division of Water Quality
Faci1lity,Nuimber O Division of Soil and Water Conservation
0 Other Agency
Type of Visit ��C,,o��mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit tdRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S Arrival Time: Departure Time: County: _ ����+✓ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: kaj'k)C C' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 Longitude: = ° =
Design Curren Desig© Current Design Current'
Swine. Capacity. Population :Wet Poultry- Capacity Population` Cattle CapacityyPopulateon
❑ Wean to Finish
® Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
I . ❑ Non -Layer
I Dry Poultry
C.
❑ Layers
Other
❑ Other t
❑ Non -Layers
❑ Pullets
❑ Turke s
IE]Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dai Cow
E]Dairy Calf
❑ Dairy Heifer
ElDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
J d
,, .
lumber of Structures <a;��
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 Q No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑N ❑NA
❑NE
❑Yes
El Yes
LJ N ❑ NA
El NE
El Yes
LJ No ❑ NA
❑ NE
12128104 Continued

r
Facility Number: 6 —
Date of Inspection 3
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: CA 60Q
Spillway?:
Designed Freeboard (in): 2A
Observed Freeboard (in): 3S
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2/1No ❑ NA ❑ NE
❑ Yes E21/No ❑ NA ❑ NE
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes L? No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E;ho ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
�,�
El o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNNo❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes❑
NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) gni) 4 b
13. Soil type(s) A,,r ,, l/,Sj,,c IG i J"(L o LY,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
,.dNo
EI No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
r❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;Zo❑ 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):
To STp r(= M e 1�-T14 C Zry
SSE StATF COOL vm) (I- DWL WAMT r -Eca2nS
rtdV_'M .
Reviewer/InspectorName I Phone: (did, 796- a
Reviewer/Inspector Signature: 4AM01f Date: _ u
A....., '7 _r? 1 71AM/Ol rnnhisiuvd

r r Facility Number: — Date of Inspection
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 appropriate box.
❑ WUP El Checklists ❑Design El Mans El Other
❑ Yes LI No ❑ NA ❑ NE
❑ Yes E(No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Ld Yes
❑ No
❑ NA
❑ NE
❑ Waste Applic 'on ElWeekly Freeboard ❑ Waste Analysis El Soil Analysis El Waste Transfers
❑ Annual Certification
El Rainfall Stocking ❑ Crop Yield ❑ IN Minute Inspections Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
21 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ldNo
❑ A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ N
WNA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
o
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes�:No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
El Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑4o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E 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
a El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
L` 0 ❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

Facility Number
(� Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit Q Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit WRoutine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I 31a. 8S_ Arri,,al Time:
o Departure Time: County. C30S L4t_) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: CI- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = = Longitude: = ° = i ❑
di
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
Wean to Finish
,014 Wean to Feeder 1 3 NO I 3$
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilt's
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Daiiy Calf
❑ Dairy Heife3
E]Dry Cow
❑ Non -Dairy
❑ Beef Stockei
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [' No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
L N
❑ NA
El NE
El Yes
L'1"No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection 3 oS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA G aop-> I
Spillway?:
Designed Freeboard (in): `ZO
Observed Freeboard (in): alp
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ff 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 EfNo ❑ 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 2(NNo ElNA ❑ NE
8. Do any oft he stuctures lack adequate markers as required by the permit? ElYes Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require [I Yes BIN ❑ NA ❑ NE
maintenance or improvement?
Waste ApLlication
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. El Yes [2'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) laULNly DA (14 ) S GO
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,Ef
NNo
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination.,
El Yes
�L
I✓J No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
FALL, 1i+Jb t' y0S9G.cTL0--J Atka S _. *JG
Reviewer/Inspector Name Phone: /b a —3R� d3
Reviewer/Inspector Signature: Date: a—f a
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. s ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
LJ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections EfMonthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3 No ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No WNA
A ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes El No
El NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes O No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No �A ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
DNo
❑ 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
,,.
2<
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
✓ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Eo
❑ NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
[91Io/[] NA
❑ NE
Additional Comments and/or Drawings: 4 ;�
12128104

Type of Visit OF Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit xRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Q Not Operational Q Below Threshold
APermitted [3 Certified © Conditional] Certified 0 Registered Date Last Operaftd or Above Threshold: .........................
Farm Name: ...... !!.,..._ . _ / 1-1....... ...... _............... County: i✓S�Gc�t4,) ..... .... _. _...
Owner Name:......_.. ............................ /? ......L�.. ,...4�D!. . .............................. (Phone No:
MailingAddress:...............----.....................................................................................
Facility Contact: .._......................... ............ —_ Title:......................... .. ..... .......__ Phone No: Wze_
®r r/FiG �fIJA'I c� /OG L dC '�.rd�!................�...[1�'` �
Onsite Representative: .................. f...... ...._......................... .... Integrator:..._. � .................... 7 .
Certified Operator: ... .................................__. _ .� ._ ._.......... Operator Certification Number:........... .
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` " Longitude �• �� ���
I}esign -. Cdrrent Desigsi Current - DiM' Current
Swine.. Ca' ci Pfl uiation , "Poa3 . Capacity ._P,oputatian ; _Cattle Capauty; "Population .
ean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
Discharges & Stream Impacts
Total Design Capacity C
z �-
Total ssLW YC
1. Is any discharge observed from any part of the operation? ❑ Yes )gNo
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 gallmin?
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 �To
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 j2rNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. ..................... ................. _...... ....._... ......... ........ .................. ................. ................. ..... ......... .............. -..... -....... ..........................
Freeboard (inches): Zb
12112103
Continued

Number: -1— y Date of Inspection p
-T�
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
❑ Yes
Q�No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
/
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
Po
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
P No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
)?fNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
XNO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Co r and/or Zinc
12. Crop type ".Amc!O GG �Pf}Z�✓�25iE��
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
RfNo
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?
ZYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes PfNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes FfNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0 No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes INO
Air Quality representative immediately.
-y! ....'.4Y" .4.- j .:. p ® •-r.z -ram '.e'u _"' n -. 4 .v� '.: -
Commciats {refer togrtest,ox� #) Explarn any YFS answers sailor any recommendattoffi or any_other comments. K _.
?Use drawer of fserlity to better ezplarn srtaatr��{use �dxhonal pages as nec_ essary) � ❑��eld oPY � ❑Final Notes j�� � -_
') lJee o ro 5r46GZ p R,4S5 4.�+ kE a,c_,�, Ro�� Gao •
�j�rl�q.-�ac.� art✓ 5�
l /pooA LO tlf-� C�J�2
`-1,4r EF n1 :5pXA`a c
0VF4ZsF
F�1J �p Aloes 9) W
R JE5 �F ram, ,4��/1oc�z�nA-, Z Y
&Ao, AP��FO
�oR
couN
Reviewerfluspector Name LEI
Reviewer/Inspector Signature:
Date:
12112103 (;onunuea

FO Wty Number: (P' f _ I Date of Inspection / p
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes XNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIT, checklists, design, maps, etc.) ❑ Yes XNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo
❑ 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 XNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes 'ONo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes 0 No
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ep!(No
28.
Does facility require a follow-up visit by same agency?
Yes 00
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes %No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes [:]No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditioaal-Cosnmentsared/or:Diavvings
f C��o� j , 4 cDR o 3 e4d 6� ln.�c�a �R �X�o.
elP
4�SOlvje 3 '6w"'r
'2"
12112103

". r -60- 04 07:59a
Carolina &•Howard Farms 252-568-6389
p,l
To: Chester Cobb
Carolina & Howard Farms
3327 Live Oak Hog Company Rd.
Deep Run, NC 28525
From: Jimmy Pollock
Re: Lagoon Readings
Date: April 2, 2004
IM
Here are the lagoon levels called in to Carolina & Howard office that were absent from
record at Cox Nursery (67-11) on 3131 /04:
2/17103
24"
2/24/03
26"
3/03/03
20"
3/10103
20"
3117/03
20"
3/24/03
24"
If I can be of any further assistance, please let me know.
Thanks,
Jimmy Pollock
4

Type of Visit 4D Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 56 Routine 0 Complaint 0 Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
0{V Permitted [3 Certified [3 Cond' 'onally Certified [3 Registered
/Farm Name:
Owner Name: - �� /��/ lea _
Mailing Address:
Time: �0
Date Last Operated Above Threshold:
County: - r /✓Z k.)
Phone No:
Facility Contact: F
_Tiitle: f� Phone No:
Onsite Representative: E lYE ��r" l gVo" Integrator
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Pi'ulation Cattle Ca „ atity Population
Wean to Feeder ❑ La er 1 1. IEJ Dairy
Feeder to Finish I ❑ Non -Layer I 1 10 Non -Dairy
❑ Farrow to Wean - — -
❑ Farrow to Feeder 1❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Discharges & Stream Impacts
t. 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)
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):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes o
ElYes No
❑ Yes No
Structure 6
Continued

Facility Number: — Date of Inspection [�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie// trees, severe erosion,
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 Application
10. Are there any buffers that need maintenance/improvement?
I I - Is there evidence of over applicatiopP , r ❑ Excessive Ponding ❑ PAN []Hydraulic Overload
12. Crop type
13. Do the receiving crops differ wA those dlesignated 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 or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(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 INO
❑ Yes /E No
❑ Yes A No
❑ Yes No
❑ Yes IZNo
❑ Yes
�YNO
No
❑ Yes
❑ Yes A No
❑ Yes P(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ YesZANo
7fYes ❑ No
❑ Yes )ZNo
15Yes ❑ No
❑ Yes A
No
ElYes XNo
❑ Yes VNo
❑ Yes No
El Yes t� o
❑ Yes PINo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
Comments . (refer to question'#) Explain any YES'ansRe7 idlor any recdmmendstianstor any other coin thents:s
,Use drawings of facility, to better explain situations.. (use additional.,pages as;necessary) �
-' Field Copy ❑ Final NotesAL
�/Di✓T�nit.{i� O OiP� �i✓ E?��� ���-�.S�fz.il� /ff�` L���/Y1G/�4,5t�
I'Se a4ons ;2!;�
H.,
Reviewer/Inspector Name 1"
Reviewerllnspector Signature: Date: 04
05103101 Continued

'
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r
i
s
'
•
J%
l
F
f
r
�

Facility Dumber: Date of Inspection lidw
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing 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?
////719
� 94 241e,- 7- / -27 L
❑ Yes �O No
❑ Yes No
ElYes 9No
❑ Yes PNo
❑ Yes A No
❑ YesxNo
❑ Yes ❑ No
05103101

i. )p Division of Water -':Quality
Division of Soil and Water Conservation
` O Other Agency
Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number M- Ci Date or visit: Thne: 11130 Printed (in: 10/26/2000
Q Not O erational Q Below Threshold
Permitted 0 Certified p Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: ...... e.... ... .... County: ...................................................
OwnerName:........................................................................................................................... Phone No:.......................................................................................
Facility Contact:.............................................................................. Title:................................... ....................... Phone No:
.........................................................
MailingAddress:.................................................................:.............................................I............................................:............................................. .......... I ..........
.....
Onsite Representative:.1-,1`!............................................................................... Integrator: ... .r.�.`.....................................................
Certified Operator: .................................. Operator Certification Number:..........................................
Location of Farm:
..
I�w
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �64
Design Current
Swine Capacity Population
Wean to Feeder
g
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars . .......
- ----------------
TEE
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I I❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impackti
1. Is any discharge observed from any part of the operation?
❑ Yes
)4 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)
Cf Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/tnin?
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
10 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
NTNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:............................................................... ....................................................................................................................................................
.
Freeboard (inches):
5100
Continued
on back

r�
Facility Number: - Date of inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
tNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
,� No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
X No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ONo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
kNo
12. Crap type t 5�-- 11 d .—�L. - GVeIZPQO�-4 _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
tjjNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
WNo
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
ONo
16. Is there a lack of adequate waste application equipment?
❑ Yes
CYNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Yes
W 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
0 No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ZNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes}
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑Yes]
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
kNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IRfNo
.. Rio yi.. I . ns o. deficiencies were noted during �his:v...... will r. e. . . .;. t'.... r. .
orrespimcence. a%out this .visit_ .. ...
Comments_(refer to question #): Explain any YES answers and/or any recommendations'or any other continents
Use d"vKjggs of facility to. better explain situations. (use additional pages as necessary)::�.
S L9) 4- (a-r3u)
�1�c � C�.�-fir � ►�� cc�-�.5 , � � � �� i � ►�PeK��r ��-2�i �t�
1r�P r .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:—o'� 7�Q j 5/00

' Facility Number: — Date of Inspection Elmo � � 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
j No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
j (No
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
4'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
M No
Additional omments andfor'Drawings:
J
5100

aint O Follow-un of DWO i
of DSWC review 0 Other
Facility Number I Date of Inspection [5/ j 6 ITJ �
Time of Inspection 24 hr. (hh:mm)
0 Permitted Certified Conditionally Certified [3 Registered [3 Not O erational Date Last Operated:
FarmName: .............�.``.. ......... ....1. 1 `"?:`........................................ County:..._... , c .............................. ................... .
Owner Name: ------------- ..... Phone No: ............................
FacilityContact:.............................................................................. Title:..................................... ..................... Phone No:
MailingAddress:............................................................................................... ................................................................................ ....'................. ..........................
LOnsite Representative:.O. . .. Integrator:....lq, ..........
Certified Operator :.................................................... .......................................................I..... Operator Certification Number:,.........................................
Location of Farm:
Latitude • 6 44 Longitude a ' "
.'Design Current Design Current ,,Design Current
=CattCaact Po lationSwine Ci aciy. Pouation* PoultryCa eityPo ulation u
,= Wean to Feeder 0 - ❑ Layer ❑ Dairy'
Feeder to Finish `.- ❑ Non -Layer => ❑Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder : ❑Other
Farrow to Finish -
- Tota! Design Capac>tty � "
❑ Gilts _
❑ Boars Total SSLW
x-
Number of Lagoons - ❑ Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
Ho dI g:Ponds / Sohd Traps:. ❑ No Liquid Waste Management System ;w ~�
_..... W
.. _ : -
Discharjees & 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. I5oes discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes �(No
❑ Yes 9No
Structure 6
Identifier:
Freeboard (inches). ....... ...............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1)-;'No
seepage, etc.)
3/23/99 Continued on back

Fa lity Number: — , Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of 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 Iack 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
IT. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20 Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Io yiolaiicjr;s or deficiet3cies -were h e� daring this:visit: You wi�� t eegive iio #'ufther
• CO' ir4inidenke: abatit this visit.
❑ Yes XNo
❑ Yes CNo
❑ Yes WNo
❑ Yes )4No
❑ Yes VrNo
Yes ❑ No
❑ Yes 9 No
❑ Yes E�No
❑ Yes )�j No
❑ Yes ONo
`Yes ❑ No
❑ Yes N'No
❑ Yes W'No
'`Yes ❑ No
❑ Yes JSfNo
❑ Yes gNo
❑ Yes ,fNo
❑ Yes 15No
❑ Yes Nf No
❑ Yes KNo
❑ Yes ,�No
rw
64-1 cyf�x�,l L �LX J.L i�-. k ,. art
S2�-. ��- �� s5'--• � ��" ,''(,��-etc-�t-�:-� �� �- ,
Reviewer/InspectorName
Reviewer/irtspector Signature: j( fie, \, Date: •5—flc -

Facility Number: — \ Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (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 permanenthemporary cover?
t�bila oIrlIItentsall or= raWings:-
❑ Yes No
❑ Yes] No
❑ Yes No
❑ Yes )qNo
❑ Yes �No
❑ Yes �O
❑ Yes&No

z-
. � Division of Soil and Water. Conservation :_Operation Review
Z 13 Division of Soil and Waier:Consekvittion-- Co`rnpliance.Inspeetion
sion of Water QualityCompltance Inspection = ¢�°
13:Other Agency Operation Review
b.
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Fallow -up of DSWC review 0 Other
Facility Number (d r] Date of Inspection e q
Time of Inspection 24 hr. (hh:mm)
© Permitted ® Certified © Conditionally Certified © Registered 0 Not OperationalOperationall Date Last Operated:
Farm Name: Nk1.N/N llf.......12.. .COS(....FIA M...:............................... ............ County: oNSc........................................... t... 2...
Owner Name: ... ENNC......r...... <-CIA, ................................................................ Phone No: ....��`..7-.....................................
Facility Contact: ...Cr�llX Title:................................................................ Phone No:...................................................
Mailing Address: ...3..6.1....... B R2 .E3E.e�.......F..�....................................................... �1 C�1� C q ni DS..........N ........... ...rrS
Onsite Representative:..67H co I • Integrator: u�Q..................................................
Certified Operator:,,N!Ert........GDX Operator Certification Number:,, l(a:S'o......
:.........Lc�;rr.�Nas.coo...K1?...�..s!�..1.�o�...�...:......u.F�F..�t.?:���xr-�................^...'.......r..S...nal.�s...----r�ar+..............TA
. �.......aa�.....�,�....................................................................................................--..............----..........------.................................
Latitude • ©` Longitude `]`j • 3 3 ` 9.
Design Current `- --: ;Design ' Current 71.Design Current.
Swine, _ Capacity Po ulation Poultry. :.Ca acity Population ' Cattle Capacity Population,
® Wean to Feeder
3$
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other =
Total Design Capacity
Total SSLw I l
(Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
;.:Holding Ponds /, Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Vaq
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -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 R No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Wo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ....... ............................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes �(o
seepage, etc.)
3/23/99 Continued on back

.�
\+
i -
�
�!
Ly
��.
.%
•: �
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f
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4

Facility Number: q — D9 Dale 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 Al2plication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
Iff"
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?
(ief 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?
No violations.....c..... were noted dirr>E . t}�..visitI . .. .will re. . Rio further . ;
:. corresnon+�ence about this visit. ........... ....... ..... .
❑ Yes ONo
❑ Yes ANo
❑ Yes 0, No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes V(No
❑ Yes KNo
❑ Yes I No
❑ Yes §(LNo
❑ Yes � No
❑ Yes 01� No
❑ Yes 1� No
❑ Yes P(No
❑ Yes Wo
❑ Yes 6ZNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes (� No
❑ Yes ,'&No
❑ Yes 34,,No
jl"23/99

Facility Number: &e7 — OC7 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 594o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ YeSA No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
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 04No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes GNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �6o
Additional. Comments and/or. rawings::.
3123/99

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number Coq - l Operation is flagged for a wettable
Farm Name: (x acre determination due to failure of
On -Site Representative: , CeX Part 11 eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name:
Date of site visit:
Date of most recent WUP:
Annual farm PAN deficit: pounds
Operation not required to secure WA
determination at this time based on
exemption El (9 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #: 'I. hard -hose traveler-, 2. center. -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system .w/portable pipe;
6D tationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
El Adequate irrigation design, including map'depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D 3irrigation operating parameter sheets, including Oa
P
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operat7ng parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE:'75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational.table in Part 111).
PART 11. 75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required. because. operation. fails -one of the .eligibiiity
requirements listed below.
_ F1 Lack.ofacreage=which Tesultedin:over:appiicaiionmf_wastewater�.(PAN) on:spray_
fields) accordinglofarm'sdast-twoyears:ofimgation7ecords.-
F2 Unclear; illegible; or lack of -information/map.
F3 Obvious --field -.limitations -(numerous:ditchesi-:failure:io:deductTequired:"..--
bufferlsetback�acreage;_or25% oftotal=acreageddentfied_.iri-_CAWMP-:iriciudes _
small ,-irregulady-shaped.fields-fields:Jess-than 5�cres-fortravelers-or.less�han
2 acres-for.stationarysprinklers)_
F4 WA determination required because CAWMP credits field (s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised April 20, 1999
Facility Number
Part Ill. Field by Field Determination of 75% Exemption Role for WA Determination
TRACT FIELD TYPE OF TOTAL CAWMP FIELD COMMENTS'
NUMBER NUMBER-2 IRRIGATION ACRES ACRES %
SYSTEM
1
FIELD NUMBER' - hydrant, pull, zone, ^or:point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system. - If pulls, etc. cross -more -than one field, 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 clearly delineated on -map.
COMMENTS' - back-up yields with CAWMP acreage:exceeding-75% of its totalzcres and havingreceived less than 50%
of its annual PAN as documented imthefarm'sprevious.two years' (1997 & 1998) of irrigation-recards-cannot serve -as the
sole basis-forrequiring a WA Deterrnination::Back-upfieldsTnust-be noted in the -comment seciion-and must be accessible
by irrigation system.
Part IV. Pending WA'Determinations -
Pi Plan Jacks --following -.information.
P2 Plan -revision •may_satisfy-75% rule based on adequate overall PAN deficit and by
adjusting -all field acreage --to below 75% use rate
P 3 Other (iefin process of installing new irrigation system):

Lagoon Dike Inspection Report—%f
Name of Farm/FaciIity �A
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH: IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
/ Names of Inspectors
Freeboard, Feet T
lL'(J,�SC 0_ Top Width, Feet t/ l
'�—I-- Downstream Slope, xH: IV 3
Yes No
Yes_ No
Yes �� No
Did Dike Overtop? Yes /Y No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed?
Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes _ No
Other Comments
C4l
0
9 1

Lagoon Dike Inspection Report
Name of Farm/Facility f P t C asc
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection �2/ Names of Inspectors Le Lj( r
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
• —3 Freeboard, Feet / 1 �r
r
Top Width, Feet l (.3
Downstream Slope, xH:1V
Yes 1- No
Yes _ No
Yes �� No
Yes No If Yes, Depth of Overtopping, Feet
Yes I ` No
Yes �� No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes � , No

Lagoon Dike Inspection Report
7- o 7 !/
Name of Farm/Facility CJ22 �-E�Ef r
Location of Farm/Facility �/ °L d
Owner's Name, Address
and Telephone Number
Date of Inspection Names of Inspectors
Structural Height, Feet 07a0,::�-)C S—D d Freeboard, Feet el 31
Lagoon Surface Area, Acres 1 �7 Top Width, Feet
Upstream S1ope,xH:1 V C;—I 7 D Downstream Slope, xH: IV
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes_ No
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Yes �LC: No
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes '�4, No
Engineering Study Needed?
Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes _ X No

Lagoon Dike Inspection Report r
Name of Farm/Facility
A
Location of Farm/Facility d 00— 1 b
Owner's Name, Address
and Telephone Number
Date of Inspection I Names of Inspectors _ V_ k _r L,-).' S
L_ P _
it
Structural Height, Feet Freeboard, Feet _ _-241
Lagoon Surface Area, Acres r� X _ 1 S Top Width, Feet b f
Upstream S Iope,xH: IV — - - 1 Downstream Slope, xH:1 V 3
Embankment SIiding? Yes_ No
(Check One, Describe if Yes)
Seepage? . Yes No
(Check One, Describe if Yes)
Erosion? Yes / No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Yes No If Yes, Depth of -Overtopping, Feet
Yes X No
Engineering Study Needed? Yes X No
Is Darn Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes No

4.
Lagoon Dike Inspection Report 7-%
Name of Farm/Facility
Location of Farm/FaciIity
Owner's Name, Address
and Telephone Number
Date of Inspection / Names of Inspectors _ i'L� ���
Structural Height, Feet O Freeboard, Feet _ z
Lagoon Surface Area, Acres _ Top Width, Feet
Upstream SIope,xH: IV 2f2, Downstream Slope, xH:1 V f
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Yes No
Vow
Yes No. If Yes, Depth of Overtopping, Feet
Yes K No
Yes �<_ No
Is Dam Jurisdictional to the Dam. Safety Law of 1467? Yes X No
Other Comments

Lav{/W
goon Dike inspection Report
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH_ 1 V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Names of Inspectors 1-7/1 e-
Freeboard, Feet
sl� K Zw Top Width, Feet _ An r
2 *D Downstream Slope, xH:1 V __ 2 —/701'/
Yes No
Yes No
Yes No
Yes No If Yes, Depth of Overtopping, Feet
Yes _ No
Yes �� No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes No

Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Names of Inspectors
Structural Height, Feet Freeboard, Feet _
Lagoon Surface Area, Acres [� / Top Width, Feet _
Upstream Slope,xH:1V c> ' Downstream Slope, xH:IV
Embankment Sliding? Yes X No
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Yes )C/ No
Yes No
Condition of !` o
Vegetative Cover
(Grass, Trees)
27
0/
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes *I/- No
Engineering Study Needed? Yes No
Is Darn Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

Lagoon Dike Inspection Report 7j/�
Name of Farm/Facility M4
� A
Location of Farm/Facility -5z /Z
Owner's Name, Address
and Telephone Number
Date of Inspection Names of Inspectors V f
Structural Height, Feet Freeboard, Feet
32S �
Lagoon Surface Area, Acres 5C 3 Top Width, Feet d
Upstream S1ope,xH:1V Downstream Slope, xH:1V 1
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of ( U
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes _ No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes _ No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes �_ No
Other Comments

Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:1 V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
6 7-/
Zell Z c
Names of Inspectors
✓; 17 cQ ��-
Freeboard, Feet
3, r-, O Top Width, Feet
- Downstream Slope, xH:1 V _ —5 '�
Yes x No
Yes X No
Erosion? . Yes _ L No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
�dd
Yes_ No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes ��L No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes No

Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH: IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Names of Inspectors
(p Freeboard, Feet
Soa?cy0o
Follow -Up Inspection Needed?
Engineering Study Needed?
r
Top Width, Feet �7>
o240 1 Downstream Slope, xH:1V
Yes No
Yes No -
Yes iv�< No
Yes No If Yes, Depth of Overtopping, Feet
Yes _ No
Yes X� No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments ��t", p ��
Yes No
f

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
lanoutine JQ Complaint 0 Follow-up of M8"Q ins ection 0 Follow-up of DSWC review O Other
Date of Inspection !O
Facility Number Time of Inspection Q' / 24 hr. (hh:mm)
13 Registered M,1Certified - © Applied for Permit ❑ Permitted 10 Not Operational . Date Last Operated:
Farm Name: x NN6TH P_ COS{ County:.......__..__.-(Q/115 4 uJ
............................................................................................................ rn .li..
Owner Name: ...... K �N ,!saH........ C d X ........................................................ Phone No:..�.Z...�L.. . `7 7 ................ 3,3 U.:...7e.?7
Facility Contact: ...!4. ...... Atc— .............. Title. �W N ......---.-----.... Phone No:....... �"'`�-....................
i'.! T/f Lo�C ................... .... ..... ..... ...............
Mailing Address:......�8.......<.�r1.'-c...(`..............I4..........C....�r-�............. ....
Onsite Representative:..... ................�G. Integrator:....................
.....' ...................................................................... y
Certified Operator ;..._.cQQ/�.....lJ�............ Operator Certification Number;._.___. P��......
.....................................D............. ......
Location of Faun:
Latitude Longitude
�
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. 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 Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the'operation? ❑ Yes ❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes CRJ-�o
5. Does any part of the waste management system (other than lagoonslholding ponds) require ❑ Yes RNO
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes XNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes fb(No
7125/97
Continued an back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (1—Agoons.I1olding Ponds, Flush Pits, etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identi Fier:
Freeboard(ft)............�a?...Z..j............................................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type >Y. �c�...........................................................................
lb. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWS4P)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations or deficiencies were- noted- during this:visit.- .You4ill receive no further
correspondence about this:visit:: :
❑ Yes VNo
❑ Yes No
Structure b
❑ Yes ;XN0
❑ Yes `�j No
❑ Yes ANo
❑ Yes No
❑ Yes A
No
❑ Yes kNo
❑ Yes 6<No
❑ Yes 4No
❑ Yes VNo
❑ Yes b(i To
❑ Yes J " IN, 0
❑ Yes ❑ Ito
Yes ❑ No
❑ Yes To
❑ Yes�No
IConsments.(refer'to question #): Explain any. ITS answers and/or any recotnmendations or, any other conunentg ' ' k I
Use rawirigs of factlEly to bettet explain sttuatinns (tise additional pages as necessary)
7/25197
Reviewer/Inspector Name
Y.., .. * <....4
Reviewer/Inspector Signature: tf/�_�, A) � /A A Date:

T
a
i

w ❑ DSWC Animal Feedlot Operation�Rp^-- : 4
Y
®DWQAn�mal Feedlot. ± ;n
10 Routine O Complaint O Follow-up of DWQ inspecE /1 F O Other
y UI a l L liJ �
Facility Number ��
ocnl-rune(in fraction of hours
Farm Status- ElRegistered ElApplied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review =
® Certified ❑ Permitted or Ins ection includes travel and rocessin
❑ Not Operational Date Last Operated:
Farm Name: �: 1.� E. ......�5_ ...._ .. r A.2wk _.... _............... County:
Land Owner Name: ............. ?. X.............Phone No:
Facility Conctact:..._._. r? ,r�-+H. - C-o �G, _.. Title: D c� .1.. .... _ ..... Phone No: ... ._.... ................... ..............
Mailing Address: .................__
Onsite Representative:.....!!! ! �. !.�....__ .... GiP X _ Integrator:
Certified Operator:....L ............... Operator Certification Number:
Location of Farm:
_ �z.�. , % s .... � .._....ram 2� ...._�..........._....__.....__..... _........ - ----- _ ....._ ..___......
_.,.. __........_. .............. ............................... ....... .....
.. ..............._..... _.... ......_ .... _ .........
Latitude r; t •©� �� Longitude �• �4 I� µ
Type of Operation and Design Capacity
Wean to r eeder
Feeder to Finish
❑ Other
Numb o Lagoons / Hvid g Pvads� ❑ Subsurface Drains Present xM f
x
F� af"�; � �� ��,�, ,��. _ _ '�< ��� � � � .n � �:Pt� ❑ Lasxoon ASprav Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes M-N-o
2. Is any discharge observed from any part of the operation? ❑ Yes E No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed., was the conveyance Fran -made? ❑ Yes Erlqo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes EMo
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 M-No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes Rgo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes U No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes -[moo
4/30/97 maintenance/improvement? Continued on back

` Faedity Number: _.�?.._. �.... }....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (1agoons and/or Holding, Pond
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
Z
❑ Yes
D-No
❑ Yes
RNo
❑ Yes
DNO
❑ Yes
�To
Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes GWo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes B &o
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .D>d. j!4. ...... ... ........ _................... ................... ......................... ............. ...... ........ ......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facilityhave a lack of adequate acreage for land application?
I8. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
(9$es ❑ No
B Yes ❑ No
❑ Yes M'90
❑ Yes R'go
❑ Yes O No,
GKes ❑ No
❑ Yes lavo
❑ Yes [moo
❑ Yes [ate
[9-Y-es ❑ No
❑ Yes ❑o'
❑ Yes Q'Ro
Comments; (refer torqueshon y#) Ezplatn any YES'answers`and/or.any recommendattans'or apy; other comments:
Use drawings of facility to better explain situations: (use additional pages as necessary)
�.elr3 twJ45 spet�qO atepmX. s pv. iks A&-6, tivwivE�t r���5 Ati— i9ol t sAv,4
►,wf4.VED. :L� Z.4 Lr-avrt Lv +Le- ne_. S -fa
4
yk&4-Lo•r e,-(At£S TWA-T- mkSIOL-) 0JtC5 4/,t5 q",s p/P3A) Foe AO trPcDATr.
a
Reviewer/Inspector Name
Reviewer/Inspector Signature: (%
Date:
/2 %
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

�f Site Requires Immediate,Attention:
/ J Facility -No. 6 -7 -
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Z• 7 , 1995
Time: o� 'o? d
FarrnName/Owner: M fz l<E rA N E TH R Cox
Mailing Address: 38 t B A R Ge45 P-D "R l C_1 # LA N D S, NC Z$ S 74-
County: 4 S c_o
Integrator: orb- Phone: _ 3 z - 3 �
On Site Representative: nrrnv . ( 5 gfl �e Phone: 3A CP: n2' 5 7-:2-
Physical Address/Location: o gF oF- s 2-! 3o z Ac.P_oss 1=_goM 52 f 9 0So �!
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 3840 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �✓4 ' 3� Longitude: -77 - 3 3 ' .39 " 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: -J_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes orWas any erosion observed? Yes or No
Is adequate land available for spray? Yes No Is the cover crop adequate? Yes,or �No
Crop(s) being.utilized: rAY` rn,-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings9/ Yes or No
100 Feet from Wells? Y��. or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or�n
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'No 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 940P
Inspector Name
Signature
cc' Facility Assessment Unit Use Attachments if Needed.

OFE RHTIONS BRANCH - WQ Fax:[phone]
f
w
L�
Jul 24 '95 18:03 P.03118
Site Requires Immediate Attention Yef
Facility Number: '%-
SITE VISITATION RECORD
DATE: X V c i , 1995
Owner: ,e. X 'tip- z-rr ,F L'v A Farm Name:
County: 922t4r 1 ♦--
Agent Visiting Site: .r .c e-c _ _ , -Phone- tr
Operator: Phone:
On Site Representative: .x. eox Phone:
Physical Address: -4 afx .r cj.+. s pa-o,,v 0,Vvd-V-e elkl
Mailing Address: .Z_8i
Type of Operation: Swine Poultry Cattic
Design Capacity: Number of Animals on Site:
J& Longiiude: _ 7 y °
Type of Inspection: Ground �' Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 FooE +$ inches) Yes or(l-9 Actual Freeboard: "� Feet r- Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? c Yes o Was there erosion of the dam?:�r No
Is adequate land available for land application? Yes oqs Is the cover crop adequate? Yes o<&)
Additional Comments:
Fax to 919 715-3559
�, r
Signafnre of Aze t

0
Site Requires immediate Attention: /UQ
Facility No. Co -11 R,
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Z cl , 1995
Time:
Z%ZO-�dU
Farm Name/Owner: '5,- (-OK- k�:t4el-kS I Ky►4
Mailing Address: _ � � -GA P-66C- f�t CH LA Nb 5 ZS S 7—
County: D N S (-o —N
Integrator: µ r toFr Phone:.
On Site Representative: Phone:
3 Z-q - 36 c3 �— .
Physical Address/Location: or - or- 5R 1-3oz Amass Fz2ow., stz 1305 nN 6Ae86G IPA
Type of Operation: Swine ✓. Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 ' SS ' 3 Longitude: 7 7 ' 3 3' 39 " Elevation: o2-O Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: Ft. 0 Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? - Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: �-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings s or No
100 Feet from Wells?(Y1s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o�n
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes OCR
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other,
similar man-made devices? Yes or to If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or
Additional Comments: Now c e'&.v • ~ in.Grir./ D�
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.