670013_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: Q Co fpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: E=-O- = Arrival Time:[.-[1—J Departure Time: County: Q j)2 6 „/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: TO D D
Certified Operator:
Back-up Operator:
Phone:
Title: Phone:
Integrator:
Certification Number: a57qt),I
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
f
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
`
Non -Layer
Dai Calf
Feeder to Finish
(aG�
Design Current
DrF P,oultn C+.a agi. Plo ,
Dai Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 W R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes Zo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Page I of 3 21412015 Continued

lFac#ity 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?
[—]Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l+h Goa h._
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 VJ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �7No ❑ 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 n 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 C2 /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):
M. 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
Vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & 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 belo
0/Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Soil Analysis
❑ Waste Transfers
[:]Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
��/)o
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
[ o
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: 7W7 - N Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes Zf No ❑ NA ❑ NE
s
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check C] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes VNo
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
To
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
No
❑ Yes
J
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
[:]Yes
rN
❑ Yes
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, comments.
Use drawings of facWtyto better explain situations (use additional pages as necessary).
'f Y ^V Fv ("oU �e
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Jbl�n, igrne�) @ rlc,den (; j od
0
Phone:1Q b J/1 J U
Date:
21412015

Type of Visit: QZCo fiance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ! Arrival Time: r7j� Departure Time: a County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ;M Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
� -i u
Design Current
Swine Capacity Pop.
Wean to Finish
Design C•nrrent
We# Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
Design Curren#
Dr. I;oui Ca aci P,o ,
ILayers
Dry Cow
Non -Da'
Beef Stocker
Gilts
Non -La ers
Beef Feeder
IR--'---od
Boars
Pullets
Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes EZI No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412014 Condnued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structur C1 Structure 2 Structure 3 Structure 4
Identifier: �dV Lw_cb�-
Spillway?:
Designed Freeboard (in): c
Observed Freeboard (in): �V J
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
ZNo ❑ NA ❑ NE
❑No ❑NA ❑NE
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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes9;1410 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z, o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Re qued Records & Documents
N. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[—]Yes FN
o
❑ Yeso
❑ Yeso
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes � o ❑ NA ❑ NE
[:]Yes rNNo ❑ NA ❑ NE
❑WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[dyes
[:]No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes eNo
❑ NA ❑ NF
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E3 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes L=J 'moo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [—]Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
facility follow-up
[:]Yes
Yes
�
YNo
❑ NA
NA
❑ NE
NE
34. Does the require a visit by the same agency?
❑
❑
❑
Comments (refer to question ft Explain auy.YES answers and/or any additional recommendations or any other comments."R;
Use drawings of facility to better explain situations (use additional pages as necessary).
-I. ) WA jj
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone a -n6-73
\4_111
Date: 4 b "�
2/4 014

tType of Visit: (Z) CCpliance Inspection O Operation Review Q Structure Evaluation O 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: Off% t, ah% Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: 1620 &Q,e f
Integrator:
Phone:
Certified Operator: Certification Number: 215 f
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
ILayer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
Dr, Pmoult . Ca aci P,o P.
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
JEJ
Turke s
Turkey Poults
10ther
Discharges and Stream 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 /NNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: -771
Date of Inspection:
Waste Coallection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
• a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LAC-yoO
Spillway?:
Designed Freeboard (in): n c
Observed Freeboard (in): "js L�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
aio ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
�Yes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� 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)
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[3 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
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
Is there a lack of properly operating waste application equipment?
❑ Yes
rN18.
❑ NA
❑ NE
Re uired Records_ & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ENa
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Othe :
21. Does record keeping need improvement? If yes, check a appropriate box below. es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis oil 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 gNo
y
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -jg Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [r� o ❑ NA ❑ NE
25. Is'& facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes WNo ❑ 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 [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 Z(NNo
❑ Yes 7 No
❑ Yes WN(o
❑ Yes No
❑ Yes
❑ Yes
❑ Yes VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments..
Use`drawings of facility to better explain situations (use additional pages as necessary).
rA-x .SoTZ, AAJA L'%r T ws ito
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
0 iz L Phonett��'6
Date: 4
zia orr

(Type of Visit: 0 CoTpliance Inspection 0 Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ] Arrival Time: Departure Time: ![yDt'i County: CPLY,L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: \0 Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Gapacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
'3 Z,O
Design Current
Dr, P,oulh. Ca aci P,o
I Layers
Dairy Heifer
I
Dry Cow
Non -Dairy
jBeef Stocker
Gilts
Non -La ers
I
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I J
keys
Turkey Poults
r
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 M'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes YNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[:]Yes iNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili ' Number: Z, 77- Date of Inspection- 'S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes � " ❑ NA El NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ 1Vo ❑ NA 0 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 M/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 O/No
❑ NA
❑ NE
[] Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
FX
❑ 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 VNo9
❑ NA
❑ NE
Required Records & Documents
W�;o
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑yYres
21. Does record keeping need improvement? If yes, check the appropriate box belo : ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ;Zo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes YNo ❑ 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? El Yes YNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes D No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 2No ❑ 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 0 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Vf/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 FNo
❑ 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? El Yes ❑ 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).
P.) Lo CA- 54R, &N4t ✓� PN O k£EP w--rM RecoaL?To
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone �d
Date: J
2/ /20I

Type of Visit: Q Zoultine
ance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: �r�J�S(A Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 1 0.0D 1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 'ry
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
-,[ Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Farrow to Wean
Cb
Design Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
D , P■oultry C•_a aci P■o ,
La ers
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
0-
Other
Turke s
key Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C3/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes gNo'
NA ❑ NE
Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:1AII I Z
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: (Ad_ tfEie-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .3l
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 ❑ ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
rNy,❑NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? []Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
lNo
11. Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Zo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Ld lv
❑ 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 ❑ N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 2<0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ l 20 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes M
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes u 'V o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

l~'acili Number: - Date of Inspection.
24. Did�the facility fail to calibrate waste application equipment as required by the permit? [:]Yes 16
the ❑ NA ❑ NE
25. Is facility out of compliance with permit conditions related to sludge? If yes, check D Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ca< ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ��No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 0 No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No
❑ NA
No
❑ NA
YNo
NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
Comments {refer to question#): Explain any YES answers and/or any additional recommendations or any other comments "
Use drawins""of facility to better explain situations (use additional pages as necessary): n_,-,�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

I/
i
Facility -Number, �_� 3
Division of Water Quality f
0„Division of 5.ot1 and,Water Conserr:atton .s
Other'Agency, x:
IType of Visit of Corppliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: M1 6 17 Arrival Time: ® Departure Time: County: 0N5t.dM6Z Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ) o DD , nm 6PE O -
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: [� c [= A Longitude: =] ° = , = «
Design Current Deslg'n Current_�� ,„ *Design Current
�,. a'
Swine Capacity Population Wet Poultry Capacity Pop.ulatton _ Cattle CapacityP,opulahon
❑ Wean to Finish
Wean to Feeder
gL1
13 Feeder to Finish
3SZA
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
❑ Non -Layer
77
Dry Poii try y
❑ Lavers
❑ Non -Layers
❑ Pullets
Li Turkeys
El Turkev Points
❑ Other Other N
3
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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
NN ❑ NA
El NE
❑ Yes
❑ Yes
,❑,
� N ❑ NA
ElNE
❑ Yes
No ❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: — 3 Date of Inspection 11
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes No ❑ NA ElNE
c4
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: A&rc LA*ow
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes L"J 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 P<o ❑ 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 thrgat, no DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes —L fi No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes Q No El 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 L✓I No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2 o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O 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
[2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
L—�"No
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C, No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
b(N o
❑ NA
❑ NE
ice; �r�,;.'-'•e"',dt''�d'�,•-,`e°a�r ad „° - .ter -. ��`x`r a.i^,��:S�ziMz�i4�" .. .,. ,.� �Rq
Comments.(refer�,to gnestioa #) Explaina'tiy YES�answers and/or any recomme dati6ns or,any�otlte comtmeats.
'Use draw�ngsg,of factltty�to better explain situadons (use-addihonal pages as necessary)
Y 7
,:.€
466L/T. Z41 rZ
Reviewer/Ins ector Name D »'
P \1 �1 111%E ,•i Phone: *0 6 --
Reviewer/Inspector Signature: Date: oZ f S-/
Page 2 of .t

,Facility Number: 6 j — Date of Inspection !S 17
Required Records & Documents ,.,/
'� 9. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes IJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D o ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q 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 El Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yeses
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3 No
❑ NA
❑ NE
No
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
I_YYes
❑ N
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[I Yes. .
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
[:3 NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,�,
E2NoNo
❑ 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
j'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
LJ N
[INA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

!3
Type of Visit QfCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f-� /�
Farm Name:
Owner Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: 0645 i ✓ Region:
Owner Email:
Facility Contact: Title:
Onsite Representative: 1 OD L-GTp 6A)
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= , 0 Longitude: = ° = L =
Design Current
Swine Capacity Population
Design Current Design C►urrent
Wet Poultry Capes ity I',opula-ion Cattle Capacity Population
❑ La er airy Cow
on -Layer airy Calf
❑ Wean to Finish
Wean to Feeder
c640
'Feeder to Finish
1j ?,o
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
❑ Non -Layers ❑ Beef Feeder
❑ Pullets
El Turkeys ❑Beef Brood Co
❑ Turkey Poults
❑ Other Number . Structures:
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ 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
❑
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
r N
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

`f
;fit acility Number: j, — Date of Inspection
i
/Waste Collection & Treatment
4. Is 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:IA(,Wj In zatl 1 5)1-�klr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CNo ❑ 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 � No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2No ❑ 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 Cl NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
VNo
❑ 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?
ElYes
E4
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J[�J/No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA ❑ NE
:Comments=(refer to question"#). Explaidaany YES. answers and/or anyr-ecnmmendations�or any other;comments
,.
Use'drawings of.facility to better explain situaians: (use additional pages as necessary).
2d) r"J 1,I16EO s %V
136 DoW t A, /Utz/ REVa / iAL
�C,yrr,WV M 6 b S
to 4 6 061 N{:
Reviewer/InspectorName
y
�fo �,,� n.. -` Phone:(1h �0
Reviewer/Inspector Signature:
Date: d
Page 2 of 3 1 12128164 i Continued

y
i
['Facility Number: (,'j — �3 Date of Inspection 3�
k
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have 141,components of the CAWMP readily available? If yes, check21/yes ❑ No ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
El2
,�o
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ <o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9-<oo
[3NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[IYes
EKo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ED
❑ 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
��
LJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
ElCI Yes
�,/
No
[I NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
I/
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑, Noo
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
Yes
Elr=
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3
12128104

r
Type of Visit (57Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9 Departure Time: County: OVf1.�1� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 n = 0 « Longitude: = °
Design C►urrent
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
® Wean to Feeder
❑ Non -La er
❑ Dai Calf
Feeder to Finish a o�
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
El Beef Stocker
❑ Gilts Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Broad Co
❑ Turke s
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes Ek o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
El Yes
El No
❑ Yes O No ❑ NA ❑ NE
❑ Yes EJ4 ❑ NA ❑ NE
12128104 Continued

��acili Number:
h' Date of Inspection �
Vlaaste 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 Structure 4
Identifier: LAntiml (A (Zu.£, &4Z_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): dy d7
95
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 WNO ❑ NA ❑ NE
❑Yes El No ❑NA El NE
Structure 5 Structure 6
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes hio ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes U No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;No
N El NA El 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ET/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
P440
❑ 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
91,10
❑ NA
❑ NE
,Z/) 0 TAT J A Tr6aaJ%t,_ Of"6.6. rVA, W
Reviewer/Inspector Name c J j Phone: M�f
Reviewer/Inspector Signature: Date: pZ
Paco?. of 2 12/7R/AQ C"nntinuod

Facility Number: c� — % j Date of Inspection
M1
Riauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C3 No ❑ NA ❑ NE
the appropirate box. ❑ ❑ ❑ D ' ❑ XA ❑
UP Checklists estgn aps Oth Wer
21.
Does record keeping need improvement? If yes, check the appropriate box below.
JZYes
❑ No
❑ NA
❑ NE
❑ Waste Applicat' n ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall Mocking ❑ 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
l"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
eNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ef o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L'I No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
dN o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
��,//
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
l-�J 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?
ElYes
ONNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
u No
❑ NA
❑ NE
Additional Comments and/or Drawings:
j
Page 3 of 3 12128104

Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: E 1 Arrival Time: Departure Time: County: c?A)SLeL.I Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: Tbhn -IhSGPf:,L) _ _- __ Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑' ❑' =] Longitude: = ° ❑
Design
Current
Design Current
�Iurlrent
Swine
Capacity
Population
Wet Poultry Capacity Population nC►attle
❑ Layer
❑ Non -La er
C►►opacity Population
El Dairy Cow
El Dairy Calf
El
51
Iq
El Dairy Heifer
Dry Poultry
❑ D Cow
❑ Layers
❑ Non -Dairy
ElBeef Stocker
ElNon-Layers
❑ Beef Feeder
[I Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑Turke Poults
❑Other
Number of Structures:
Wean to Finish
El Wean to Feeder
$`i0
3 3
Feeder to Finish
3S
El Farrow to Wean
❑ Farrow to Feeder
Gilts
EFE]l Farrow to Finish
Boars
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
dN0
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field ❑Other
a. Was the conveyance man-made?
[I Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
e. 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
�❑�/No
Ld No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
eNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12/28/04
Continued

Facility Number: (or] — 13 Date of Inspection Z5 G
9
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?
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6,,60N 1 CA (7-M � L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2q 2-3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E�No ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes P To
❑ Yes ❑ No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t�hr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes YNo
❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L7 No ❑ NA ❑ NE
maintenance/improvement?
l I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ff� ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes [rNo NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �No
❑ NA ElNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
Phone
Date:
12128104
Continued

I Fgcility Number: 13 Date of Inspection u
i
R? uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes OINo El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CJ No ❑ NA ❑ NE
the appropriate box. ❑ W`UP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U/Xo
❑ 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?
ElYes
o
[INA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
rJ o
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WYN9�
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
[:3 Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ETNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2No
❑ 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
❑ Yes
fJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O/N4
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Addidonal;Comments andl.orAira mgs a �f°
"
Page 3 of 3 12128104

Type of Visit C7opliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access.
Date of Visit: 67 Arrival Time: dC Departure Time: County: ��t"� Region:
Farm Name: Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact: `�i Title:
of
Onsite Representative: 6i� 0 r Lia Y �p e
Certified Operator:
Phone No:
Integrator•
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0O ❑' = Longitude: [� o
Design
Current
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry Cwopacity Population
C•atile Capacity Population
❑ Wean to Finish
❑ La er
airy Cow
®Wean to Feeder
rj 'lo
6
Layer
airy Calf
91 Feeder to Finish
3 5 7.c D U
ll
❑Dai Heifer
❑ D Cow
❑ Non -Doi❑
Beef Stocker
❑ Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
rD Poultry
ers❑
n-La ers
lets❑
ke s
❑ Beef Feeder
Beef Brood Cowl
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J�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
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
W o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WN o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 41 — f>
Date of Inspection
`Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: tAA)d&l S¢ C61 09A) 029MY
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 3 S
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 El Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes []'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
E�YNo
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
LJNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0<
Zo
[INA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
!,d
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name , 0,qA/ X-AfLL L Phone: 910 ! — 3 fr
Reviewer/Inspector Signature: Date: 6
Paze 2 of 12128104 Continued

Facility Number: Date of Inspection J
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box.
❑ WLTP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 E No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes D<o ❑ 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? ❑ Yes E'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes El'*No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
YDNNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ 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
RI 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
,�/
L7 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
'LI' N
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
L,�J No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

e
0 Division of Water Quality
Facility Number O Divisiol.n of Soil and Water Conservation
- -- Q Other:Agency
Type of Visit OAC mpliance 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: 1i a Departure Time: County: 611r(fL eb"' Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: jj Title:
OnsiteRepresentative: Opp
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swipe Capacity Population
❑ Wean to Finish
® Wean to Feeder
y o
a ke
® Feeder to Finish
U
6,p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
1 Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: E__1 o E__1 E__1 Longitude: = ° = 1
;Design Current Design Current;
Wet Poultry Capacity Population Cattle Capacity Populatiu
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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?
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N ❑ NA
❑ NE
❑ Yes
❑ YesNWoo
❑ NA
El NE
El Yes
El
❑ NE
12128104 Continued

Facility Number: -7 — 3 Date of Inspection S vy
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Dlo ❑ 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: ANAS&A'tU o
Spillway?:
Designed Freeboard (in): ZO 7A
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E(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 YNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [3 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W� ❑ NA ❑ NE
maintenance/improvement? 17
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) G W
13. Soil type(s) P-A 4,TJ
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
0 No
❑ NA
❑ NE
[ANo
El NA
El NE
[��/ No
❑ NA
❑ NE
LY No
❑ NA
❑ NE
EYNo
❑ 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):
AO -A',. ANb [.�lt•bS U�I���ab•
1W
Reviewer/Inspector Name "O"A N !� �L ii Phone: NZO) 77 7d b
Reviewer/inspector Signature: Date: V
Page 2 of 3 12128104 Continued

Facility Number: 63 — 3 Date of Inspection b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,_ JNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box.
❑ WLJP El Checklists El Design El 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 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[TNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
24
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q-'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
04
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C3 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
l o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CTNNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ET/No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

0 Division of Water Quality %
Facility Number OD =3 0 Division of Soil and Water Conservation
Other Agency
(Type of Visit G(Compliance 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. e7S Arrival Time: ® Departure Time: County: OWS' . Id Region:
Farm Name:
Owner Name: ,
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: � DD 1-14 G &E j
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0' Longitude: = ° 0 i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
3$ L jo Cs° ❑ Layer
❑ Non -La et
® Wean to Finish
® Wean to Feeder
Feeder to Finish
35 Z,o
(deb
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
❑ Turke s
ElTurke Poults
❑ Other
Discharges & Stream Impacts
1, is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
ElDai Calf
❑ DairyHeifej
El Dry Cow
ElNon-Dairy
El Beef Stocket
El Beef Feeder
El Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
i\
`? 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 L' 1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
❑Yes
❑No
❑Yes
INN
El NA
El NE
El Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: f 3 Date of Inspection d'
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: 50
Spillway?:
Designed Freeboard (in): 7A Sm
Observed Freeboard (in): 33 3 2- ,(
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes u No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental 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 L7 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 C1 'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;No
N El NA El NE
maintenance/improvement?
I t . 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 Cl PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) W )A E S4 I
13. Soil type(s) QA—ZK�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[J�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LJ
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P4)
❑ NA
❑ NE
ITse drpwtngs of facdtty to better explain pagesYasanecessary)
al.) VOATE -UZO _�{ ► LLD y Std LX 1-0 G� Fa nm 5 i 12AW 4iFIL- KA r►�-FALL
KE�e COPY I)f AA JUA'L GE AZT WST4 fzbGefu
FAdZr1 CA° ICS GfLe Ar,
Reviewer/InspectorS
Name o};j �1; U , Phone: 9c V -- SPO y t03
Reviewer/Inspector Signature: gXA1 Date: V 610 S
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 ❑Maps ❑Other
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ElWeekly Freeboard ❑ Waste Analysis ElSoil Analysis ElWaste Transfers
eAnnual Certification
Rainfall El"Stocking 01crop Yield ❑ 120 Minute inspections ❑ Monthly and I"
❑ �
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
;7No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Lj�N
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LSN
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
D E
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E I 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
,�
U No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2rN.
❑ 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
EK/
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LI No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit A Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit P(Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Aocess
Facility Number Date of Visit: / Tune:
Q Not O erational Q Below Threshold
,GfPermitted © Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ........... .
Farm Name: ...___ .. ..� ._.. ._.
.&P!h.......... ..-cuiiiity:... _
Owner Name:__ ................................................... �!.1. ✓i�!.........1 ffi�r1>�........... . .............. Phone No : ..................
MailingAddress: ..... ...... ................................................... . . .... . ....... _._. ... .
Facility Contact: Title:Phone No:
--- ---- ----
Onsite Representative: ... ... Integrator:.........
Certified Operator: . . .................... . .................... . . .. ................... .......... ... I . . . .......... . ... Operator Certification Number: ..... .,... .................. ..... ....
Location of Farm:
21 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 9 " Longitude ' 4 66
f :invent L
5vrine
Wean to Feeder
Feeder to Finish
- Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
u ❑ Boars
Poultn
❑ Non -La}
Other ~
Number of ]Lagoons �_ Z -
�vHnlEi�iiasFnnflc {:RAIM"i'rat►c:
Dai
Not
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ YesINo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N0
.Structure 1 r'5:�'r
2 Structure 3 Structure 4 Structure 5 Structure
Identifier: ... A& ................ ... .................... ...... .................. ._.......... .......... ............. ...... ...
Freeboard (inches):
12112103 Continued

'acili umber: — `, Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes �--y o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yeso
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes FfNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes',,�No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ YesNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes �o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C_, . (f!
i
13. Do the receiving crop&ffer with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes zrko
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes �No
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 00No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ZNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes E 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 0<0
Air Quality representative immediately.
3-5) IL460 � .DO�in,ENr
f" -
16C LJ�Lz­
Reviewer/Inspector Name
❑ Field Copy ❑ Final Notes
V, PF'Cr � 1414 rZA " z�
Reviewer/Inspector Signature:
Date:
12112103 Continued

)Facility Number: — Date of Inspection
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ZNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes ONO
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ONO
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
0/No
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes 2r&o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes �To
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes �No
28. Does facility require a follow-up visit by same agency?
❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Xyes ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes PrNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ONO
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ONO
34. Did the facility fail to calibrate waste application equipment?
❑ Yes )9No
35. Does record keeping for NPDES required forms need improve ent? If yes, check the appropriate box below.
❑ Yes [XNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall coon After 1 "Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no farther correspondence about this visit.
12112103

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
13 Date of Visit: S r/ 02 Time: 10 : 30
Facility Number rj
Q Not Operational Q Below Threshold
U Permitted O Certified © Conditionally Certified ©Registered Date Last Operated or Above Threshold_
Farm Name: +/l� U I� „v„„�'r•..q .-. County: n �10 tn)
Owner Name: __Mee --�---h=-'------------------------ Phone No: ---------------------- ----------------- ---
MailingAddress:•-•................••-----•-•----•...................................•-•-.......................................--••---•-•-•..........................................................
Facility Contact: ........................................................... Title: ..................: Phone No:.....
Onsite Representative: _ 7_Ddd _- J �_�� �' 1 integrator.
Certified Operator: ........ . ............................................. Operator Certification Number:
Location of Farm:
[]Swine []Poultry ❑ Cattle []Home Latitude • 9 OK Longitude • 4 �u
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
. ❑Yes RfNo
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)
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ''No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) Iess than adequate? ❑ Spillway ❑ YesdNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: __• /Ci v!' sir .�.. ._; s ti ,r -
Freeboard (inches): Z-rl

VJ/V3/f!f
Facility Number: CV 17 — ) 3
Date of Inspection Z
1'ununueu
S. 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 Aaolication
❑ Yes ONO
❑ Yes j2No
❑ Yes _Z-N-o
❑ Yes '2-1�qo
❑ Yes_2',lo
10. Are there any buffers that need maintenance/improvement? ❑ Yes Jrlo
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [I Yes j2l` o
k 12. Crop type V � —,°► � ) so y b e q,? s
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ' ❑ Yes_oNo
lb. Is there a lack of adequate waste application equipment? ❑ Yes E04o
Required Records _& Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ETNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) Yes ❑ No
19. Doss record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) 1'es ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ZfNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes _La"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/j�rNo
24. Does facility require a follow-up visit by same agency? ❑ Yes �ffNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ YesXNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comm refe Ito uesho E lain�an YFS answers:and%r`an recommendat ai ns3or an other commenf`s .
;Use drawmgs�of f cdity tome er explamisitui bons. use pa es as necessary :_
additional t
Field Cop ❑ Finai Notes
� 1(s
14. `TL.e wQ Am&4,�e� .�'ory
I- 1e, acre4e ,7 s �►�0 acrEa�e �P�E��r -fie
41, ` 1d }
`J�j check w �941, Qc'-ea G and g Lorr42��cd
'4 4v
P
r o Rr] 7✓e o�VR Ot
, �. 44e F';�„sL�,r�9 jgr�oo✓t ' Con-�ac� �hC
19. Need /m oon efes; Jch i.l-Fo,-Aic �;a�9
D;s4-,-C4 44, ob+,t;vt co'07 aVId
Name Reviewer/Inspector c '.� c� Ii% lrl " - = ► s : z.. '
hsl _ _z ._ .
Reviewer/Inspector Signature: Date: J� ~f O
j_y.. __ ­... ", _....._......_._....,_...•• ........s,n«,,.rK,' _,_tn _......_--_-----

Y
Facility Number:
Date of Inspection OL
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, j
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ,8 No
❑ Yes RfNo
❑ Yes OINO
❑ Yes �No
❑ Yes J314o
❑ Yes ❑ No
Additional.Cumments and/or Drawings:
`Tt'eee "S no 4./Oi4e anal Yyis d44ed k/;A;n 64 A or
R Ae y f V zq-hour eve7-!s I/y - #106tJA
4 a a 1, M, . 7io' yen says A q�/ ;/ 4e e oL e7 la '1g 4;'-In e
-fie ge-I ¢he rPs L, 14S -15e 44e .sa w h,'Cln eveOuall~�
cG�te baG� da �i 1111 b�4! .The rCV i ouS gnIt1 s S )111 t�
y
91-
VJ
A)CM 40 h-we .Sgnrn le`wr �t irL�. r; p e •1 Set y s - o a ,- - e Sor •� p le i h 4 64 o be,' ZA4 / -
is d;Af'iCz?14 4o hots/ i� 4 2D611 Sat���S-1 lef4i
cx; S, Tr►� Qec some ✓'es HS- bv4 -Ake �POn4 F49e Iv"4k Ae
da4e dr 4 is no4 .1Na *Iq ble 1n5pee4,6h 4he,-e �� ^ A jn1
Per' fr'G!U'lf'o� d'*JJ':cv14. LR&9YVI"e -1a have soil
Aave de6tA1e?q&111'oU1 Jvailpble for Ver%F:c2�,o� _
05103101

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j•

}gI?tvrsion of Water Qiahty F ~
Q Division of Soil andVa#er Conservation
0=0#her'Agency.
- r
lType of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation j
Reason for Visit qkRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: r�Cr-C1 rime: ® Printed on: 7/21/2000
��
Q Not operational Q Below Threshold
APermitted 0 Certified [] Conditionally Certified Q Registered Date Last Operated or Above Threshold: .........................
Farm Name: �' u
\r�.p..-�............................................................................... County:.-........................................................
Owner Name:........
Phone No:
FacilityContact:..............................................................................Title:............... ............................ Phone No:
MailingAddress: .....................................................................................................................
Onsite Representative: ,••\„V �p`'ti „• Integrator:.-...,,•,----,•
........................`. '`, .......-.................................
Certified Operator: ................................................... ........
Location of Farm:
•. Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° Longitude �• ��"
Design Current
Swine canneity Pnnulation
Wean to Feeder
13'71JQ
Q
Feeder to Finish
a6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons F 10 Subsurface Drains Present ❑ Lag -Ann Area ❑ Spray Field Area
Holding Ponds I Solid Traps 10 No Liquid Waste Management System
Disebarees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discltarge is observed. did it reach Water of the State? (If yes, notify DWQ) El Yes ❑ No
c. If discharge is observed. what is the estimated flow in gallinin?
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 ;Eq No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ANo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure I Structure Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ...........R............
-..........
Freeboard (inches): 93 a-3
5100 Continued on back

Facility Number: — `3 Date of inspection I 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 j�'No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes kNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
W No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
1krNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
eNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
VNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
14 No
12. Crop type S� Y� �G�-•s . V\-ely
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
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
�fNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
NrNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
WNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
1NrNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
WNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
NrNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
M'40
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
ONo
(ie/ discharge, freeboard problems, over application)
❑
23. Did Reviewer/]nspector fail to discuss review/inspection with on -site representative?
❑ Yes
WNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
0: Rio •violations:or• deficiencies 4� re h6ted• du�rtrig Ihis;visiC • Y;oii will •reegiye titi further - : • :.I
• . • corresooridence: a'bout. this visit:
Coinments (refer t[j question #): Explain any YES answers and/or any reconimendations:or any oilier eomnients.
Use drawings of facility.to better explain situations. (use. additional pages as:necessa
i5_SL4 o -�
s,
-Ash ,
Reviewer/Inspector Name v z,._ e
Reviewer/Inspector Signature: Date: ` -si r G ( 5/00

[ Facility Number: Date of Inspection dLC3 d( Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below XYes �4M
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes R No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes r
0
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 KNo
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 O"No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes'Alo
5100

Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility :dumber Date of Visit: Time: ® Printed on: 7/21/2000
Q Not O erational Q Below Threshold
Permitted E3 Certifi d © Conditionally Certified 13 Registered Date Last Operated or r bove Threshold: .................
Farm Name: 011eV�/G. Count': o ....I ..................
...... W.....................'.............................................. a.....................................
Owner Name:
Facility Contact:
............................................................. Title:....
FlailingAddress: .......... ................................................................................................
Onsite Representative:....,�. Q .... ...!-.....................
-�........
Certified Operator:
Location of Farm:
Phone No: ..........................
Phone No:..
....................................................... .. .. ............. I ............
Integrator:....., t^ ................................................................
... Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• 0` �� Longitude �• ��«
Design Current
Design
Current Design Current
Swine
Capacity Population
Poultry Capacity
Population Cattle Capacity Population
Wean to Feeder
G
❑ Layer
I
I
'
❑ Dairy
I
I
Feeder to Finish
M
JE1 Non -Layer
I
I
❑ Non -Dairy
::d
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons oZ ❑ Subsurface Drains Present ❑ Lagmin Area ❑Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
kNo
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. II'discharLe is observed. what is the estimated flow in gal/thin?
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
XNo
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
XNo
Structure I Strut Lure 2 Structure i Structure 4 Structure 5
Structure 6
Identifier: .............. t%................ .................................... ........ ..................... ...... .................................... .................................... ......................
..............
Freeboard (inches): 3ed, as
5/00
Continued
on back

R
r-
0
w

Faciiety Number: —71 Date of inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes VNo
(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 applicatiof 7 ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type sG� -•S ! (,.+�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment'?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: N' violaiigtis :or• def eiencies •were noted• during this; visit: - Y:ou ;Will receive Rio further
corres�&ide_ & about: the visit::: :
❑ Yes 9No
XYes []No
❑ Yes XNo
❑ Yes gNo
❑ Yes JYNo
❑ Yes XNo
❑ Yes tKNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 12CNo
KYes ❑ No
0Yes ❑ No
❑ Yes XNo
XYes ❑ No
[]Yes KNo
❑ Yes XNO
XYes ❑ No
❑ Yes j (No
❑ Yes tKNo
❑ Yes R(%No
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):
Q .f1
4a� ��O
c,�(
Reviewer/Inspector Name [ ���] -3 q � X � (
Reviewer/Inspector Signature: Date: c) 5/00

Facility Number. — ` Date of Inspection Cep printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge it/or below Ves ❑ 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 M�No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes &No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes M No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes CTNo
Additional.Comments and/orDrawings:
C4 �� C�ge►�,P —�'1` 'TD � CG ti \jl �►—�-� W�� �7 N G ,
e��ac�,rct
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,. M:Division of Soil and Watter. Conservation Operation Review ` Y y
- C Division of Soil and Water Conservation =:Compliance inspection o g
® Division of VLWater-Quality . - Mp mnce Iiospec6on d
OwOther Agency OperaReviw tion e' ` M
w
Q Routine Q Cum faint Q Follow-up of DW2 inspection Q Follow -tip of DSWC review 49 Other
Facility Number Date of Inspection Js- ZZ
Time of Inspection 2.4 hr. (hh:mm)
Permitted [3 Certified [] Conditionally Certified 13 Registered 3 Not Operational Date Last Operated:
Farm Name: Wrli C vdd Lie r ; FGi � County: „ 1 SIl�-hl.......................................................
............................. r....--- S•........--............................
Owner Name: �Y �..!1 . �' L ! �°�. Phone No:
..................... <J p...-..............................................................................................
FacilityContact: ............................................................................ Title:.............. ............ Phone No:...................................................
MailingAddress:...................................................................................... .....................................................................
Onsite Representative: .............1........ ..........(yY' 1 l' .......... .. Integrator:.... 1.e. �L?, f t'....................................................
/Y� 1ch e ......
CertifiedOperator:................................................................................................................ Operator Certification Number:,.........................................
Location of Farm:
.....................................................................................:................................................:..............................................................................................................I....................
Latitude 0 4 •1 Longitude ' 4 41
Design Current =` Design Current = Design Current
Srvine Capacity Population ...,:Poultry , Capacity Population =-Cattle . Capacity Roptilahon
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of I.agooiis=
� Mold nig.Ponds / Solid Traps
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
❑ No
Waste Collection & Treatment
❑ Yes
MINo
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2' Structure 3 Structure 4 Structure 5
Structure fi
Identifier: ur` iQ1 i xsI
r1
Freeboard(inches): ................................... .......11.... r..........J................................................. .......................... .......................................
...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
0 Yes
❑ No
seepage, etc.)
3/23199
Continued on back

A-Ir
0
A
X.

ra sty Number: (a`7 — �3 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 maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This -facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
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•yiolatiotis:or• deficiencies ere h0 er3 ilwitig�his:visit; Yoi� will•rebs iye do further .
comes orideike: ahtit f this visit:
Comments (refer to question #} Explain any YES.answers and/or.any recommendations or any other comments.
Use drawings of facility to bettenexplam sitdat.ons:'(use additional: pages as:necessary)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes X No
❑ Yes ❑ No
❑ Yes ❑ No
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ec) V I'►w) �)7��
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Pie gfat• -;an Off' sUiti►V..ee
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7
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ReviewerAnspector Name l.n.CW,) } L 7f'li
Reviewer/Inspector Signature: Date: 2 Z�,o,

t ��'

Revised Apn120, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number bn - 13 Operation is flagged for a wettable
Farm Name: acre determination due to failure of.
On -Site Representative: ar,T ,'% Part 11 eligibility items) F1 F2 F3 F4
InspectorlReviewer's Name: M-a-}11 ; S Operation not required to secure WA
determination at thi "me based on
Date of site visit: q exemption E1 2 E3 E4
r
Date of most recent WUP: Operation pended for wettable acre
determination based on P1 P2 P3 .
Annual farm PAN deficit: ? pounds
1
Irrigation System(s) - circle #: 1. hard -hose traveler; 2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system wlpermanent pipe; 5. stationary sprinkler system wlportabie pipe;
6. stationary gun system wlpermanent pipe; 7.,stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility Tailure, Part II, overrides Part I exemption_)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
_ZE2 Adequate D, and D21D3 irrigation. operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE_
E3 Adequate D, irrigation operating parameter sheet, 'including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part 111. (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 1I1).
PART 11. 75% Rule Eligibility Checklist and .Documentation of WA Determination
Requirements. WA Determination.requiredbecause. operation failsmn_ e of the.eligibility
requirements listedheiow:
_ F1 Lack.of-acreage whicnTesultedanmverMpplicabonmf-wastewater (PAN) on:spray.
fields):accordingto7arm'sdasttwo--veas-uf rrigationz-econds.
F2 Unclear,Jllegible,or lack ofinformatonmap.
F3 Obvious #ield-limitations-(numerous-ditches;faElureto:deductTequired _
buferlsetbackmcreage;.or25%:ofdotai:acreage3dentinedan-LAWMF::mciudes _
small '-irregulady-shapedfelds = flelds-less#han-5acresfor.travelers-orJessthan
2 acres1or:stationary-sprinklers).
F=! 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 IH

Revised April 20, 1999
Facility Number , -
i i N
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT FIELD TYPE OF
NUMBER NUMBER'-2 IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP FIELD
ACRES %
COMMENTS"
_
I
1 9 I
L
FIELD NUMBER'- hydrant, pull, zone, or:point numbers may be used in place of geld numbers depending on CAWMP
and type of inication-system.- If pulls, etc. cross-more#han one field, inspectodreviewerwill have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER2 - must be clearly delineated an map.
COMMENTS' - back-up fields with CAWMP acmage:exceedng75% of its total -'acres -and havina received less than 500/6
Of its annual PAN as -documented in the farm'sprevious-two years' (1997 & 1998) of irrigation Yecords,-cannot serve -as -the
.sole basis -For requiring a WA De'Lerm_inaiton:hack-unfields-must -be -noted in the -comment sectonmnd mum be accessible
by irrigation -system_
Part IV. Pending WA Determinations -
P1 Plan Jacks.folloWnainformation:
P2 Plan revision T12y_sabsry75% rule based on adequate overall PAN deficit and by
adjusting -all field acreage�o below 75% use rate
P3 Other (iern process of instailina new irrigation system):

Division of Soil andpWatersConservahon -.Operation-Review -
0 Division of Soil and Water Conservation _--Com Lance inspection
T P, �.,
Division of Water Quality -.Compliance Inspection
= _-
- . [j Other Agency: OperationrRevtew
Q Routine Q Complaint Q Follow-up of DW2 ins ection Q Follow-up of DSWC review ® Other
Facility Number 13 Date of Inspection
__ .. Time of Inspection 24 hr. (hh:mm)
© Permitted © Certified [3 Conditionally Certified 13 Registered [3 Not Operational 1 Date Last Operated:
�vv/1'l County- QNS%
Farm Name: ""�� (/Br A /�.i
...............................................................................................�... •...........
Owner Name:........yy�.,.. f V t 1 l @Y} 2 13 /:.................
f'1�..................• .. .................----.....�h .- PhoneNo:......��8 �,-ul018--��Znf
Facility Contact: �0 4�� Title :.............. Phone No: ...................................................
MailingAddress:.............................................................................
Onsite Representative: .ee..V ..`..�.....—Fli!'. 01
....................... V�.......,
Certified Operator :...................
Location of Farm:
.................................................n.................................................... ..........................
Integrator: .... Ale.q.! 1. f ..............................
................. Operator Certification Number:..........................................
r
......................................................................................................................................................................................................................................
Latitude �° i Longitude • ' "
Design Current. _ Design Current
-Swine `_ Capacity Population' -_ Poultry --Capacity .Population Cattle
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Layer
[]Dairy
❑Non -Layer
❑Non -Dairy
- ❑ Other
- Total Design Capacity
L
�� ...
., Total SSLW
Design Current
Number -of Lagoons Subsurface Drains Present ❑ Lagoon Area 04 Spray Field Area
Holding Pondi / Solid Traps E= ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If c ischargc is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gat/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: n%�� 1 T/Z'� .. .............................
Freeboard(inches): ........................ ................ ........................... .................................... .................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
❑ Yes ❑ No
Continued on back
3/23/99

Ao%
/I
I
9

Facility Number: — !J? Date of InspectionI
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
+--clo"stite plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency"situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0: io •vib afmis:or defdenc{es were ngted during t. s.v. sit. You wil. -re&M �i6 furth+ r
ctirresoricence. about tftis .visit. . . . .
Comments (refer to question;#): Explain aiiy YES answ..ers and/or_any recommendations or:any other comments..-
Use drawings of facility to better explain situations .(useadditional-.pages as necessary)
• Ad v scd-Qrmer- 40 Llock chq•rne f -��.t� leads -/,ram s�•�4 t, �;'�Jd
� d•�ch 9c�as� �e/d�a����''Dl;" �6 Spru.�j i'� . /
l
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: R IV fa
3/23/99

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- [3Division of'Soil and` -Wafer -Conservation -'Operation Review
Division of Soil and Water'Conservation m ;Coplipna Inspection
Division•of Water.Quality -'Compliance Inspection
Agency Operation=Revitew __ - _ r _ "
jig Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Fallow -up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted © Certified © Conditionally Certified ❑ Registered 1E3 Not O erational Date Last Operated:
Farm Name: .................q.TG.....(7.V �" ...,�! S SI A�......_............................................
W ............... . ...............................:........... County:.............
Owner Name:.......... "%�'' U r N �J a
............................�..'!:...rI�i....---........._............_................... Phone No: ......................_._........_..................................................
FacilityContact: .......... _ ..................................... ............ Title: .................................................. ,............. Phone No: .............................
MailingAddress: ..................................................................................................................... ....................
AL-l'i
Onsi#e Representative:...,,,, I,faAL11..... ..1.... .` �. .. Integrator. ..h."..................................................
Certified Operator:,,, ........... Operator Certification Number: ...
.......................................
..................
Location of Farm:
Latitude �� �` �` Longitude
Design Current -_ Design Current . _ e -
Swine Ca acity Po ulation ",:Poultry: Capacity Population Cattle
ES Wean to Feeder
3 Q
3
Feeder to Finish
35 2b
3SZa
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons
HoldingPonds'/ Solid Traps
❑ Layer 0 Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other 1 1—
--:_.
Total Design Capacity
Total SSL-W C
�' ❑ Subsurface Drains Present 10 Lagoon Area
❑ No Liquid Waste Management System
Design Current
.apacity Population
] Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes X No
❑ Yes No
❑ Yes ( No
hfa
❑ Yes ® No
10 Yes [:]No
❑ Yes 'Z No
❑ Yes `® No
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 W No
seepage, etc.)
3/23/99 , Continued on back

J�
M � r
• i
r1

Facility Number: -- Data (if Inspection
w
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes X 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 k No
8. Does any part of the waste management system other than waste structures require maintenatice/improvement? ❑ Yes gj No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? 9Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding }A PAN Yes ❑ No
12. Crop type Ggrr►A^ SCE
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 14 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
0 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
JgNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
]J 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
'S No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
t6Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
29 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
91 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 9 No
23, Did Reviewer/Inspector fail to discuss review/inspection withon-site representative? ❑ Yes 21 No
24. Does facility require a follow-up visit by same agency? ❑ Yes %No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �( No
0; 10 yiolafions;oT ¢efficiencies mere pofe'd' Aiiting this:visit: • Yoit wiil-r;eceiye iio #;ui-thgr
corres oncieirce about tlxis :visit..... • • . • ............ • . • -
Comments (refer to question #): Explain any YES -answers and/or any-recotnmendkidis or.anY _-other comments.-
,Use.drawings of facility to-b'etter'explain situations (use additions Lpages as necessary)
2. l,,Ia4e,keh oh J" q9.
A 9
1i• OV"'* )il,4iOh F ) se
p(a PAllj ep� bus . � Donon a f ��af a.v/1,ctil/
it eel nad -'PAAJ 14,14mnf 1A - SIX. ooerarllrc.4;on) 1-8V/ S)6) ,jeid 2 -e-/% a.
!�i- ��ep L,,ee�l� l�aDh .Freeboard Jeyc)t. /1/tt,.� INs�S� ^ns��1S�f°"`rz�°.
nQd6s • Keep Se ' / - eE 4 W l ret and
T
ReviewerAnspector NameAl
Reviewer/Inspector Signature: Date: „3
,� 3/23/99

,,
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Facility Number: b?— 13 I Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29_
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
&t No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
broken fan blade(s), inoperable
Yes
N�No
or shutters, etc.)
❑
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
ftX No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
9 No
_ itiona ...Comments and/or, _ raw*gs
' So1�be %kiS Rave beeh ,Spr4 ed eAre qao ;n p/q>1.
1 rie!d r added 4a foJ�n -�h a{' �tr e 90 ; ng fa �I
�a• & 1< C JAo n✓ -/.r T1'147 l �T►�OM S�O�"a� �'�ldl �Y1Td C�i�G�
)�I
?d a eV to Ir'un 0A7 rAS�c.
3/23/99

Lagoon Dike Inspection Report
Name of Farm / Facility _ Mervin Thiglen Matchoyerya Farms)„ 67 - 13_�
Location of Farm / Facility Qf[Hwy 258 Pond # 1
Owner's Name, Address Mervin Thigl2m 128 Kirby jWSpen Read_ Pink Hilt
and Telephone Number NC 28572 910-298- 4618 _
Date of Inspection 9 / 29/ 99 Names of Inspectors Zahid Khan
Vincent Lewis
Structural Height, Feet 4-6 Freeboard, Feet 20 inches
Lagoon Surface Area, Sq. Ft. 127,100 Top Width, Feet 4
Upstream Slope, xH:1 V _2 to 1 Downstream Slope, xH:1v 5 to 1
Embankment Sliding? Yes X No
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Yes X No
Yes X No
Condition of Vey Csoad Grass cover
Vegetative Cover
( Grass, Trees )
Did Dike Overtop? Yes x No
Follow -Up Inspection Needed? Yes _X No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
If Yes, Depth of
Overtopping, Feet
-Yes X No

a
k
Lagoon Dike Inspection Report
Name of Farm / Facility Mgrvin Thigpen (3Vatchoverya Farms) 67 - 13
Location of Farm / Facility Off Hwy 258 Pend # 2 Nurse ,Lagoon
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Sq. Ft.
Upstream Slope, aH: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?
Mervin Thigpen 128 Kirby. Thigpen Road_ Pink EW1
NC 28572 910-298- 4618
9 / 29/ 99 Names of Inspectors Zahid Khan
Vincent Lcmdg
4-5 Freeboard, Feet 8 inches
44.100 Top Width, Feet 3
2 to 1 Downstream Slope, aH:1v 5 to 1
Yes X No
Yes X No
Yes X No
YM Good Grass cover
Yes X No
Yes X No
Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
If Yes, Depth of
Overtopping, Feet
Yes X No
Other Comments Pond # 2 needs to be Humped and inspection
,port given to the operator.

z❑Division of Soil and Water Conservation ❑Other Agency"
Division of Water Quality
3141
.ate
outine O Com- lain[ O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection S d0 24 hr. (hh:mm)
Registered QJ26ftified [r Applied for Permit O Permitted [j Not Operational . Date Last Operated:
Farm Name: W. .,q, }..Qv.1 R..-.yp^'...... County: �1U ?.c.1..............................................
Owner Name: hl E2t!/t 4 P� rJ Phone No: /4 `� ' S� (o /
...........................................................................................................................................
Facility Contact: Title: IC.Gvt ......................... Phone No: ...................................................
MailingAddress :.......;..Z....?i�� ... ............................. ............................................................................... ..........................
Onsite Representative:.....T ,t..!] . cSP6� .............. Integrator:....... A ,k.. o.,F'.......................
Certified Operator ,........... t2p...l)......J!s t. A�//0 .....-�!'`............................................... Operator Certification Number:...l.�..I..".'...1..............
Location of Farm:
..............................................................................................................................................................................................................................................................I............
..`.. r. .......�lI1.4Ar/ ru � .....Lf� b.... .7...-i..3..................................................................................................... .........
Latitude ®•' �"
Longitude ,
©• �' ©"
F Design , Current
Design - Current; D.esign,.. , Current ^
Swine `
,
Capacity Population
=Poultry
=Capacity Population Cattle ., ; Capacity Pnpulattan
A
. _.
Wean to Feeder
¢77
❑ Layer
❑Dairy
Feeder to Finish
,5 ZO
❑Non -Layer
_
❑ Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder
0 Other
❑ Farrow to Finish
r Total Design Capacity
❑ Gilts
n Total SSLW "
❑Boars
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any.adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7..Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes N(No
❑ Yes E�(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ONo
❑ Yes
XNo
❑ Yes
9No
❑ Yes �To
❑ Yes kNo
Continued on back

Facility Dumber: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La oons,Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
Freeboard (#t):.........3.a.Z........................2... .......
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
❑ Yes WN0
❑ Yes KN0
Structure 6
❑ Yes C�No
11.
Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
LXNo
12.
Do any of the structures need maintenance/improvement?
❑ Yes
[6`o
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or tnaximunt liquid level markers?
❑ Yes
ONO
Waste
Application
14.
Is there physical evidence of over application?
❑ Yes
O(No
(If in excess of WMP, oyrr runoff entering waters of the State. notify DWQ)
15.
Crop type .......................r. ]!G'............ ......................................................... .............................................................................
......... ....... ..........
.........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
I (No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
RNO
18,
Does the receiving crop need improvement?
❑ Yes
M10
19.
Is there a lack of available waste application equipment?
❑ Yes
`�210
20.
Does facility require a follow-up visit by same agency?
❑ Yes
(WNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
((No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
❑ Yes
�Vo
,'[ \i\
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N'o
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
GkN0
0 No.violations or deficiencies were nated-during this. visit. - .You4ill receive na ftirther
cofrespbndence about this:
Cotnrrtents`(i4eir.to question #) 'Explain any tS ':ins-*6rs•and/or any reconimendations,or any other comments .
,t
i3se drawings of facdtty=tti better°explain sttuallons ('u`sc additionaFpages'as necessary} x�fti
+-0 uk '5F
7/25/97
H
Reviewer/Inspector Name ITT . t J2fZt�•%r'�,,
Reviewer/Inspector Signature: Date: p

i
® Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DS8VC review O Other
Date of Inspection ti
Facility Number
7�'::= — - - --------- Time of inspection j O 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review]
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:..... .,�.............. ..... ..... r....'
Farm Name- t., f A "�'C:4 V.�"� �.�..._�!°' ���.. �z County:.
Land Owner Name: r�.l..� ... 4_.PE,t!1_ .....�............. Phone No: .................
wl
Facility Conctact: �7 L�1� ....._ .. Title: _ .... .. ....�.........._. Phone No:... _ __.... ...........
Mailinb Address: ��.y�_� l't — _ ....._ ._... w N t ... .... .. �.......�........
IJ
Onsite Representative:.....!..; ;;.1��, ...._.I JA L ��� Integrator: N 4_ ...
Certified Operator:.... ..� a.._......... , 4 ..`!''. `LrN Operator Certification Number:
Location of Farm:
Latitude 0®1 yy " Longitude ©• ®©"
Tvoe of Operation and Design Canacitv
ig Current' Design 'YCurrent = Desi n Current
Swine€ „ Des n l'oultr3' w�Ca aci Po Mahon : Cattle : .Ca` aci " Pa' `ulahoi Ca aciP,o ulation.
Wean to Feeder uU j❑ La a ❑ Da'
Et 'Feeder to Finish SZ a ❑Non La er ❑ Non Da
Farrow to Wean _ .. gw'
Farrow to Feeder Total Design Capacity£
Farrow to Finish �� ,'',•`� k� � � ``�°%s
�.�SSLW �
fr❑Other k
r�
�>
Number of Lagos /Holding Ponds ❑Subsurface Drains Present
�, ���'�y� ,� '. ' ,y� n� � °i��� � u� � � V �,¢ ��� ❑Lagoon Area ,* ❑Spray Field Area
!Qene.ral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes
B-fVo
❑ Yes
®filo
❑ Yes
EMo
❑ Yes
Ej__No
❑ Yes
8-'90
❑ Yes
[�Io
❑ Yes
[I -No
0-Yes
0 No
Continued
on back

., ' r --Sility Number: .(.t.-2.., 7` v5-
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes B NO
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 Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft). Structure I Structure 2 Structure 3 Structure 4
2.5- 2•(41
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?
❑ Yes [Ergo
❑ Yes Qua
❑ Yes IIQo
Structure 5 Structure 6
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 -... J'r........... ...._.............. ........ ........ .....
_ .. _...._...... _ .........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
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?
Fgr Ce0fiedFacilities 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?
Commenu {refer to question'# :Explain -any YES answersand/or:any recommendations or`any;other comments.
Use drawings of facility to Better expIaia situations.: (use additional pages as necessary}'
(tee � v�rs'+ '�7 • mot- w � [ f 5 ,
❑ Yes &N6
❑ Yes QNo
[9`5e-s ❑ No
❑ Yes 0-90
❑ Yes No
❑ Yes [;]-No
❑ Yes CEO
❑ Yes 19-NGo
❑ Yes Q'No
❑ Yes ®Ko
❑ Yes [I-X-6
❑ Yes ❑ No
❑ Yes ❑ No
2`9�s ❑ No
Reviewer/Inspector Name
Reviewer/Inspector Signature: n G Date: Alall
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires immediate Attentio ` A-1 O
' Facility No.
DIVISION O ENVIRONMENTAL MANAGEMENT" J_
ANIMAL FEEDLO OPERATIONS SITE VISITATION RECORD
ATE: 1995
Fairm Name/Owner: Wg
Mailing Address: /
County: QNSLo -
Integr=- r. Nnu.%A
On Site Representative:'
Physical Address/Location:
Type of Operation: Swine
Design Capacity: 3 Ste- b
DEM Certification Number: Al
Latitude:' 5F ' 5511"711
Does the Animal Waste Lagoon h
(approximately 1 Foot + 7 inches)
Was any seepage observed from d
Is adequate land available for spry
Crop(s) being utilized'
Does the facility meet SCS minim
Is the animal waste stockpiled wit
Is animal waste land applied or sp,
Is animal waste discharged into w,
similar man-made devices? Y
Does the facility maintain ade
spray irrigated on specific
Additional Comments:
' " d '0 -
Inspector Name.
Phone:
Phone:
G�'`�
Poultry Cattle
Number of Animals on Site:
DEYi Cerdfcation Number: ACNEW
Longitude: ?7 -0 u. Elevation: Feet
Circle Yes or No
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
'es or No. Actual Freeboard: ;- -Ft._ Inches
lagoon(s)? Yes o Na Was any erosion observed? Yes or No
Yes or No Is the cover crop adequate? Yes or No
= setback criteria? 200 Fzct troin D\ve1fings 'e's or No
100 Feet from Wells? Yd� or No
n 100 Feet of USGS Blue Line Stream? Yes or,,Noj
.y irrigated within 25 Feet of a USES Map Blue Line? Yes o
ers of the state by mart -made ditch, flushing system, or other
orb If Yes, Please Explain.
waste management records (volumes of manure, land applied,
ge with cover crop)? Yes or(fo
L -A
4b
Signature
cc: Facility Assessment Unit
s 1 ,• 9ud
Use Attachments if Needed-
DN 371-1If1tdOS.ADNf NH3 W0�]3 -C.`1 SGI E gnu

0
Fj
Site Requires Immediate Attention: /�J6
' Facility No. & 7 —/ �
DIVISION 01 ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDL01 OPERATIONS SM VISITAMN RECORD
ATE: 1995
Time: `� r
Farm Name/Owner.
Mailing Address: _
County: C9n3s
Integrator N ^-&- . f
On Site Representative:
Physical Addraess&=ation:
PPE1r
Type of Operation: Swine ✓
Design Capacity: _l
DEM Certification Number. ACE_
Latitude: 3 4- ` ,' , q4 %7"
Does the Animal Waste Lagoon hl
(approximately 1 Foot + 7 inches)
Was any seepage observed from d
Is adequate land available fors ra
Crop(s) being utilized: :
Does the facility meet SCS minim
Is the animal waste stockpiled with
Is animal waste land applied or spr
Is animal waste discharged into wa
similar man-made devices? Ye
Does the facility maintain adequate
spray irrigated on specific acm
Additional Comments:
M
Inspector Name
cc: Facility Assessment Unit
/b!'cj'j Ac
Prone:
Piton: _-�Ly �_ - A- /
Nu_ �t '!Oren•, ati le-r t
1, 5 rn i (c c
Poultry Cattle
Number of Animals on Site:
DEM Certification Number: ACNEW_
Longitude: 7 7' S T Elevation: Feet
Circle Yes or No
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
'es r No Actual Freeboard: Ft. _ Inches_
lagoon(s)? Yes Was any erosion observed? Yes o N
es r No . Is Este cover crop adequate? �S'
r No
-n setback criteria? 200 Feet from Dwe1lingszs or No
100 Feet from Wells? i es'- r No
a 100 Feet of USGS Blue Line Stream? Yes o
y irrigated within 27 Feet of a USGS Map Blue Line? Yes o
ers of the state by mars -trade ditch, flushing system, or other
or o If Yes, Please Explain.
waste management records (volumes of manure, land applied,
ge with cover crop)? Yes or No
17
i
Signature
Use Attachments if Needed.
bi0'39dd
3N 311InN0S`1Dyf LiH3 W0�l3 S6:7_1 s6: 6 �DNt�.