310056_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Date of Visit: l / Arrival Time: { 3 D Departure Time: ®1 County: Region: -
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
{�
Onsite Representative: t/ r CA C p N k Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current Design- CurDes Current
Swme Capacity Pop ' Wet Poultry ;Capacity og le . Capacity Pop
5
�K r� _
a
Layer DairyCow
Non La er DairyCalf
'nk ,.�« r a c5' re* r Dal lleifer
Des n Cu
„ eat D Cow
;D ;Poult nC acPao� Non-Dairy
gym;;
Layers
Beef Stocker
Non -La ers Beef Feeder
: Pullets Beef Brood Cow
: +,� Turkeys
e" Turkey Poults Other...
Other Other
Wean
to Finish
We -to Feeder
eder to Finish
" � �'s�
Da
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yeff s 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? ([f yes, notify DWR) ❑Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Ye No ❑ NA ❑ NE
Page I of 3 2/4/20I5 Continued

Facili Number: 71 - 56 jDate of Inspection: / r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): "l 2-- 37 39
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 EfNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 4-rNo
-- ❑ 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 Cf No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
N�No
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
El Yes
❑ 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?
es -0 No NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
ro ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes❑
NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - S,6 jDate of Inspection- 7
24' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes A�oD
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NAB❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ©"NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes No ❑ NA ❑ NE
❑ Yes I_ .1 4o ❑ NA ❑ NE
[:]Yes No 0 NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No NA ❑ NE
NA ❑ NE
❑ No ❑ NA ❑ NE
Reviewer/Inspector Signature: Date: S / 3 l
Page 3 of 3 2/4/2015

r
SD Division of Water Resources
# Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Co fiance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:® County: t, Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: CAR_aO(, C11T,'LC
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Integrator:
Certification Number: 1211 S r15_
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Non-U
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (1f 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

f
Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 7 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �— I A (. 66_6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3g
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ 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 ZNo ❑ 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 envi onmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? f Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 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? ❑ Yes [/]t o ❑ 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 N ❑ 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 yr� ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EfNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall InspectioFNo
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❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes dN ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in. any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes ❑ o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 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?
24. 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 EfNo
❑ Yes Ef"No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
eNg
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (referto. 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).
►JE es Do � E � �"� Ig �� C-��N � nlC� r3yi ctl tvF or fAC
��. Lap- Ca a-D, d b7-AVl %Ic,J oA16
ReviewerlInspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: �!(Q 9
Date: S c
2141JO15

(V Division of Water Resources
-Facility Number - 0 Division of Soil and Water Conservation
I���LL��JJJJ 0 Other Agency
Type of Visit: 0 Co 71liance 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
nn.... 0 Denied Access
Date of Visit: J 1 Arrival Time: Departure Time: County: Di'O Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: CA aA �oc), C!,
jr't!� Integrator:
-
Certification Number: 3 q
Certified Operator:
Back-up Operator:
Location of Farm:
Design,. Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 5,606
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er I +_ I
Non -La er
Design Current
Pullets
Other
Pouets
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Wl�o
o ❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facilitv Number: - IDate of Inspection:
- • - - r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
61'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ON E
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2fNo ❑ 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 EZ('No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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
t2. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q o
❑ 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
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z�4
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Fd/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ 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.
6/yes
❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�rNo
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility —Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�No
0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o
❑ NA ❑ NE
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�o
❑ NA ❑ NE
Other Issues
Z1140
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
dNo
❑ 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
E�/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
C� o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[] Yes
,I No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
'�, ,�'Wl�4LL- �C- hiEE� RErno%P aFIr 9, 6
9,J) 06 11"R41AIReL , -Z/sfEC_at'1V-f .
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
r

Division of Water Quality
Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Co pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: D—w—aLi Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: CWOLL CArLC. Integrator: �1
Certified Operator: Certification Number: 22 3 i
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish Ivy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Laver
Non-L
Pullets
Turkey Points
Other
Design , Current
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[—]Yes E�/No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes Yl�o
o ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑Yes xo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection: S
Waste Collection & Treatment
4' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No 0 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: oN I t.i ogty t-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 --qj_:� ji
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
ff 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 o770sn
'mental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes r�/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [%f No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ['No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[,7No
❑ NA
❑ NE
IS. Does the receiving crop and/or land application site need improvement?
❑ Yes
� o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C2� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�40
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E/No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. LEIYes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes d
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes g �No
❑ NA ❑ NE
Weather Code
Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaCility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes O(No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesgNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes Z(No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. 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 Ej`No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [� ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
q) 5'44gL., Tkktf 0E6-P ;K6pVtA411
21.I zlocgVE 3i,W6�(- AAJn CALXSM-J�Wd
Reviewer/Inspector Name:
Phone: C f�
Reviewer/Inspector Signature:
Page 3 of 3
Date:

W Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency -
Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: O Departure Time: County: t7UPLIJ1 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: coltxk Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
X Feeder to Finish j Z
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Latitude:
Phone:
Certification Number: 2 `3 �
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Ion -Layer
Design Current.
Pullets
Other
Poults
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?
Longitude:
Design Current
Cattle Capacity Pop.
Daig Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef B
road Cow
[-]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o 0 NA ❑ NE
❑ YesrNo
❑ NA ❑ NE
[-]Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&01 1 UA( WO1 L A(s>W)3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): " 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes PNo ❑ 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? dYes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0No ❑ 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 or improvement? -- //
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;? No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[—]Yes
[n No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Zyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C?rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�IN o
❑ NA
❑ NE
Reauired Records & Documents
Yes
NA
NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available.
❑
rr/No
❑
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CdNo ❑ 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 "11Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes VNo
❑ 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

FaciliNumber: jDate of Inspection: VIP
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes arN) ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j(No ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes WNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes o ❑ 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 VNo
N ❑ 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? 2"Yes [:]No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any: other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
SMA► L, - Tt-. E s o d Qi.r-P- w AuS >Jc.4- o F. f3 c P-fiNwVC 0
Go `DABS=
Ib') Lr^5 Oc-"t-'P '>N 5EVL AL. rzCL,05, SG-o NEC-05 '(o Mot.Yc',
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
� rA 2A)6Li,
Phone: u a (o) ` C4
Date: t b
21412011

(9 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit: Co pliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up 0 Referral 0 Emergency 0 Other Denied Access
Date of Visit: $ 1 1L Arrival Time:® Departure Time: ! a2s County: Region:
i
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: CA R0_6U L_ Ca_Wt_F_ Integrator:
Certified Operator:
Phone:
Certification Number: P a i r S
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Pullets
Other
Poults
Design Current
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?
Longitude:
Cattle
Design Currents.
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ENo ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No/ ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
F5-No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: ?, - Date of Inspection: t 3 t 2__
' t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Stricture 4 Structure 5 Structure 6
Identifier: LA ,,,N i LA &e60 7__
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 143 ([3 '3 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes O/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 1:2�40 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes E/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes CZ(/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 dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ET/yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes Fj/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
F]"No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0_Nc ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FZ/No ❑ NA
❑ NE
the appropriate box.
❑VAR []Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑Waste Application El Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 4? t3 1 t✓
.24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
.25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: /
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes VNo
o ❑ 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
❑ Yes
CZ 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
EZ/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
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
O/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
rn c
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FO/No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers andfor,any additional.recommendations or,any other comments , '
Use drawings of facility to better explain situations (use additional pages as necessary).
GE ttpjD uw 6epj 3 045 C>EEN Izc- c-E 6LT w.-C C- s-lsLU, AJ4,kb
L 66-D S?AAY-_T_�JC , 17o(.VM&wf Apt) (2E r C��'
Reviewer/Inspector Name: �,) of q t� oj� t (lam
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Cara ! ! 9( —� V
Date: l l3 /17---
1
21412011

I
kadl ,
ty; Number '
__ _I
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency..
Type of Visit co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Viiss-iit�t-- d� Roouutine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: fn Title:
Onsite Representative: _.f,A6-40LU C=UL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity.. Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 6 2'gdb
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
� ❑ Boars
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e Longitude: = ° = g = f1
Design Current �i:Design i
Wet Poultry Capacity Population Cattle �Capacty Pi
] Layer
] Non -Layer
Dry Poultry
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
..
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑N El NA
El NE
❑Yes
El Yes
❑ NA
❑ NE
❑ Yes
LJ No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — S 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?
Structu e i Struc�e 2 Structure Structure 4
Identifier: f
❑ Yes 2No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 3Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L�'No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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?
[2 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
LNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�'No
❑ NA
❑ NE
Comments refer.to Fueshon # Ea lain an YES -answers and/or an recommendations or an other comments'p` �1
( q ) P Y. .Y Y ��
Use drawis of faculty to' better.explain ng. situations. use additional pages as necessary): <a
7) 6AC1"=E DI Et<o s CL cA�.z . a;; SMAL4— 6,jj$4ES 7b 1-66 ,
A6
15,E PvL4,f (-VAIEE1P -r0P/UL6PVAjt 00 trowLA �l��. C56f ,PJ
1CFf Cad;' /✓►9Sr6 AA/Rl.�f�f 1�7f/ ���f SG-6 A SAf
l.}
O.ft— CAI-- A166a-P AT .TA)JP6 CT_W PAX wig AAtaLV4. V, CA"
ReviewerlInspectorName .;fin/ Phone: 796 -'13��
Reviewer/Inspector Signature: Date: �!
Page 2 of 3 1
12128104 ' Continued

Facility Number: 31—S Date of Inspection S li
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other ,
21. Does record keeping need improvement? If yes, chec the appropriate box below. 'LI Yes ❑ No ❑ NA ❑ NE
El Waste Application El Weekly Freeboard l� Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WN
� o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El yes o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes LYNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? � Yes ❑ No ❑ NA ❑ NE
❑ Yes Z El NA ElNE
❑ Yes7No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
o
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesIN
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
No
❑ NA
[INE
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?
ElYes
El NA
El NE
If yes, contact a regional Air Quality representative immediately
ZNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
0No
E No
❑ NA
❑ NE
r
A7dditi64a!°Comments and/or Drawings:'
Page 3 of 3 12128104

FAcil►ty Number
j
vision of Water Quality
vision of Soil and Water Conservation
her Agency
rtN .:k
Type of Visit Ckornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Gd Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 ji7 Arrival Time: 30 Departure Time: County: ()UPI=j.I Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 0 « Longitude: = ° 0 . = w
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Z$aV
trwa
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
[I Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: E]
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
r
❑ Yes L'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes g o ❑ NA ❑ NE
El Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 j — Date of Inspection a
aste Collection & Treatment
4. Is storage capacity (structural plus stop-n storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (AG,,M L-:�C�ooe J 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32 l �(p
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 M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ElNE
ElYes CZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Lj<o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dN0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
DNo ElNA
❑ NE
15. Does the receiving. crop and/or land application site need improvement?
Yes
El—
�'No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Z"No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
'❑ NA
❑ NE
l$. Is there a lack of properly operating waste application equipment?
❑ Yes
FNo❑ NA
❑ NE
NA r k $ max.✓ w<'w�G"= '?:�:'�+' x'�� t'-x„3 F 4 4Y iy «.
Use drawings q ) ex lain situations. Comments refer to `nes#ion:# :=-ExplaEa.any YES:answers and/or Shy,.recommendatrons or any other comments h
wm s. of faci ' to better ns use'� -
..
g hty p (use 'additional- pages as necessary); : w ;-
Reviewer/Inspector Name' ,� Phone: %
Reviewer/Inspector Signature: � Date: '7 10
Page 2of3
711721114 r•,.,,�;.,.,o.r

Facility Number: — Date of Inspection t f
I
Required Records &_ Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0�l o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (2No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi gn ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EX/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 InspectionsEl
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
Fe No
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
E3No
[INA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2/No
❑ 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
[410
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes DI�o ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L'J 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
EI 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
4ErNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,,��
LE,!!
3 o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
4J No
❑ NA
❑ NE
Additional Comments and/or:Drawings:
Page 3 of 3 12128104

141
..Division of Water Quality
actijty'=Number` 3�. SG O?Division of Soil and Water Conservation
D OtherMAgency'
Type of Visit C mpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ElDenied Access
Date of Visit: Q o Arrival Time: 6d0 Departure Time: County: QVA LRegion:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
OnsiteRepresentative: ulzxecu C_TrUz Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = d =il Longitude: = ° = d =
is
Design Current Design Current
Capacity Population . Wet Poultry Capacity Population
h La er:P�
❑ Non -Layer
❑ Wean to Finis
El Wean to Feeder
® Feeder to Finish
2�C9O
2
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
ElTurkeys
❑ TurkeyPoults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field [I Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
❑ DairyCalf
El Dairy Heifer
❑ D Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Co
Number of Structures: EJ
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes L'J No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facilikty Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EZ/No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA(Sex AJ 1 LA Nyuy z to
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
FNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
C�rNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
ENo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
�xo
❑ 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
[A/No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
ZNo
❑ NA
❑ NE
l7. Does the facility lack adequate acreage for land application?
❑ Yes
L No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ NA
❑ NE
Comments (refer, to question #): "Explain any.YES answers andlor;any recommendations or�iny other comiiients
Use drawings of facility to better explain situations. (use additional pages as necessary) "
uEF o To I�t~M a 6
S [-o A PrZC_77W &A,-
Reviewer/Inspector Name I p I Phone: U 176 %3�d
Reviewer/inspector Signature: Date:
Pnoa 7 of 1 12128104 Continued

Fachity Number: — Date of Inspection o
Required Records & Documents
V-
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�No ❑ NA ❑ NE
the appropirate box. [l WUP ❑ Checklists ❑ Design ❑Maps El Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E3"'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
[No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
Z'N' o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit? -
❑ Yes
0 No
❑ 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
W No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
ET'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,�,/
ICJ 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
2fgo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
eNo
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2 No
❑ NA
❑ NE
Additional Comments and/or Drawings::
Page 3 of 3 12128104

® Division of Water Quality
Facility Number SG O Division of Soil and Water Conservation
t'k 11 O Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 6 D Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: L' AR UL4_ Geit(� _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
�o
Latitude:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Longitude: 0 0 = & = {i
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 112SOo - I F 2856
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ on -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE'
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [No ❑ NA ❑ NE
❑ Yes [2(No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 j — Date of Inspection 5 +
Waste Collection & Treatment
!j 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LJ 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: to &a.-J L LA 3
Spillway?:
Designed Freeboard (in): I9 • S L4 �S L�
Observed Freeboard (in): 'Y7 yl 37
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yeses E�No [I❑ 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 D No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ' El Yes LJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 6 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/ improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O 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
QNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
['] Yes
❑l No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ETNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1Si) 38 kA%?J se R.C"M %JC- 31-0 8AL,FJ QK 14AY, CALL 6LJW wH6tO paJE..
L
er/Inspector Name v 614 FA Phone: 9/ber/Inspector Signature: Date:
li/iu/V�► l.VlLLLlLuGLL

Facility Number: Date of Inspection
a Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ld 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?
El Yes
._,/
IL! No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
�No
[INA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2(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 �No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[A 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�[?�No
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�(
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
2 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

r 11
Facility Number
Q Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
lType of Visit Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit. C Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: G .Z�i o(a Arrival Time: Departure Time: County: -&I _ Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: CAfL.n.o�.c.__CU-MA_E Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
❑ o
Latitude:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Longitude: ❑ ° = ' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish I a1.'goc
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish I
❑ Gilts
❑ Boars !
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
j
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes C4 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
El Yes
VNo
❑ NA
❑ NE
❑ Yes LI No ❑ NA ❑ NE
12128104 Continued

Flcility Number: a - Date of Inspection a�4 Wo
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure
6
Identifier: LA Gam,J I LACvoor f Z- LACac J 3
Spillway?:
Designed Freeboard (in): �t't , S i Ct a 4 .
Observed Freeboard (in): 1 - yt• ag
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.)
dNo
)❑
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
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
f N
ElNA
ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
/
Q o
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,�,
L1 '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) 3 W S 6 C>
ll
13. Soil type(s) A crtm Sgau WC-Y MA Q--d`>'1J �+�iw)To+u
Na fl..Fot
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Eallo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
❑ NA
[I NE
17. Does the facility lack adequate acreage for land application?
[IE Yes
S"No
,
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
BNo
❑ 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):
Imo,) S'EV"AL Ott 43ALIES o NAY AT EQ[sE dF F'x�IJD „ieEO t'o St.EwoJE, +
CU"E y Cam- � � �rM� WAS R.�•C � � aur Lot TMI F� � N�
Gao" LT
Reviewer/Inspector Name 1 3 R &LL. _ I Phone:QQ/D )_)T6 _ 93 69
Reviewer/Inspector Signature: Date: �aQ1c�L

Facility Number: 3 — S' Date of Inspection a OL
Required Records & Documents
19. Did the facility fail to have 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 WNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1�40 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections, �❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes
L�'No El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El YesNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes [TNNo
ElNA
ElNE
ElM Yes o
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes N o
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes
L_rN/q
ElNA
ElNE
ElYes
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

t ODrvision of Water Quality .
Facility Number Q Division of Soil and :Water Conservation
Other Agencv� r =
�'4v -4ri: `S•M'i��a.." �; �7i_^..` } ��_ - A c ,. ♦.- - n ," i . � .. : r. �, .. ♦a. .. i _. _. .oV ... ,
Type of Visit QJCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ;0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
' J
Date of Visit: 29 Arrival Time: Departure Time: aunty: �PG�� Region:
Farm Name: G/! / Owner Email:
Owner Name:1Q%l�G�• �7'Gf Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: l4 1244fZy1f-- e4?reA�- Integrator: LIM�d5oRd
Certified Operator: GL [.[r/�� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑' ❑ Longitude: a ° = ' ❑ "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
��� ❑ Layer
❑ Non -La er
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ®E
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes JgNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes VNo
❑ NA
❑ NE
❑ Yes ;ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes 0 No
❑ Yes ❑ No
El NA ❑NE
El NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
�
Spillway?:
0 O
Designed Freeboard (in):
Q, J ��,5 .5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any oft ' he structures need maintenance or improvement? ❑ Yes /No ❑ NA ❑ NE
8. Do any of the stuetures lack adequate markers as required by the permit? ❑ Yes �No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes RINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drifl El Application Outside
�offArea
12. Crop type(s) �FQmV496 f ,qv � Jl �_ UeX-,-, 6D
13. Soil type(s)
z44,_e 1774,evvAl
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
Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑
Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
//� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
refer, totesoi4S�$$EangqN� w}nalnyCmhl Yrrecomms
wmgfatyo be#teregplamditioncitwiuendations or any other comments.
pages as necessary):
rJ V�����Z�,cDS r'�/�� � � .�i%7"l%D✓Zr/G rt�7�✓[��
Reviewer/Ins ector Name A'" �h �'° 0--
p i f_ r ,� Phone: l
Reviewer/Inspector Signature: Date: fj
12128104 Continued

. t.
Facility Number: — Date of Inspection+(o7/p5l
_Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
gNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
/No
❑ NA
❑ NE
the approprrate box. ❑ ATUp ❑ Checklists ❑ Design El Maps ❑Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
;ZNo
❑ NA
❑ NE
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J0
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
A NE
Other Issues
I
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
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
P.111o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
t
No
❑ NA
❑ NE
A'ddthoAal Coniments'aadlor:Drawings ;.:
- °
"'
Z 7P�-z�f��� Neto-,0F� L' � nn
/Qi�zr� FL�rJ� An�,D /`�'T 6,4ST
V_n 1. , L X-M 6 ��cxFT ��r�o 3/o las
j „*�
[/" f' �EQ L-t r--5 7 CA��
A41?
Sc.ulJc-tT

-� � llrv�sion of Water Quality � _ � � 322!~~�
O Drv�sronafSo-'and Water CunservatEon j
Type of Visit is , ' Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other © Denied Access
& ZO-1 - - I Facility Number Date of Visit:
O Not O erational Q Below Threshold
Permitted © Certified Q Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName: ....Ll.ab_A:�_..c ..... ............. ...... ...... .......... .._.... ..... County: L�,f1........ ................ ........ ....... ....»............
OOwner Name: �O
...� ��'.r2 �J..............� �...__.......`....r..................._......_...... Phone Na:............................._........................�......._...._...
MailingAddress: ......... .......... .................... ................ ............ ...... . . ..... . ............... . ...... .................................... ......... ........ ........ ........... ........ ............. --.........
Facilitv Contact: .................... ... - ... _ .. .. �� .� .... Title: Phone No: ..---- - ......................
Onsite Representative: „.1�/�2 L( �L�Q�. %� .� .. Integrator: .................... _.
Certified Operator: .. . ................ . . . .......................... .. . .... . . . . .... . .. . . ................................. Operator Certification Number: .............................. _..........
Location of Farm:
�Kswine ❑ Poultry ❑ Cattle ❑ Horse Latitude �* �' �" Longitude �• �' �"
Destgu y
Current gn Current = Desin < n Design` Cnrreut
- s _
Swine :Po uiatton P,onitry
�,. _Ca` a
, .. .
R. Wean to Feeder
Layer Dairy ❑
Feeder to Finish p
Non -Layer , ❑ Non -Dairy
El Farrow to Wean
p
10 Other
El Farrow to Feeder
Farrow to Finish
•. - 4 '~ =
Total Des>€gn Ca�aaty
GiIts
' Boars
5»'r iQLA1 SSL 77x
- .., .-.. .. _, .....,
�,
.. ... . =�. -
Number of Lagoons
77
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes P<o
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 C-.Ko
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 12,90
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Struct e l S cture 2 Se Structure 4 Structure 5 Structure
Identifier: ........T............ .. - ....... _....... ....... - -
Freeboard (inches):
12112103 Continued

1 FacHk Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Analication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN /Hydraulic Overload ❑ Frozen Ground Copper and/or Zinc
I2. Crop type ��Ql]V/ /T4! ) �ineeC- l_4 li'L/J Dv`/Lsel5v)
13. Do the receiving crops differ with those designated in the Certified Animal
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?
❑ Yes XNo
❑ Yes ZNo
❑ Yes ZNo
❑ Yes QfNo
❑ Yes 'VNo
❑ Yes No
❑ Yes No
(CAWMP)? ❑ Yes
A No
❑ Yes
YNo
❑ Yes
❑ No
❑ Yes
❑ No
itYes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes 'A No
❑ Yes �No
❑ Yes eNo
❑ Yes VNo
❑ Yes r5ff'No
eCoatntents (re%r to gtiestion') E �cplaun any�YFS a savers snd/o� arty recomaiendaiioas o any omen comments. :
'.Use drawings of facipity tv better explain s�tnatons (use aiddxteorsai pages as necessary) ❑ Feld Cop ❑ Fin Notes
Z6057
-ems
/.,: �
nt
1Z k"' Z" /* aL
aw
ReviewerAnspector Name
Reviewer/Inspector Signature: Date: /B
12112103 .. Continued

Facility Number: al —
Date of Inspection S
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management PIan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes W�No
❑ Yes PfNo
❑ Yes INO
❑ Yes No
❑ Yes X No
❑ Yes/�"0
)"Yes ❑ No
❑ Yes f�No
❑ Yes 6ONo
❑ Yes A No
❑ Yes 21No
❑ Yes tj� No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. I
2i A140
`(/O��S ,E25/�,,r�i✓�' G5� 2- 49�W �lUn/ (�5�i✓c
4111_11�__ Af'N�Ivlo AV/--)
tlSES Imo/ 171Aztlze- , a60
.12/I2103

' . J_�
- Mii Wdtr of Water Qi6LUty _
Q_Divisivn of Solt and Water Conservaticin rt
_ c
y
0 Other' -_-
Type of Visit compliance Inspection 0 Operation Review 0 Lagoon Evaivation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number irate of visit: 7 ime:
10 Not Operational OBelowThreshold
Permitted ©Certified © Conditionaafly Certified Registered Date Last Operate or Above Threshold:
Farm Name: Ou.� �� �_1 �Q .. _ County: EN
Owner Name:
Mailing Address:
Phone No:
Facility Contact: T}'le: Phone No:
LC aTTL� I�RGr�T �7C� - �rOt�wkp
Onsite Representative: � integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle
❑ Horse Latitude 0'
�� 0 Longitude
0'
T - Design
Current - _ - --
Design Current.
DesMn Current
Stone - `_ -: e: Capacity
Potiulation ' ; .Poultry - , -
Capacity "PovulAtioa -: Cattle
W . _.Capacity P6 ulsttan ,=
i__I wean to reeaer
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Number. of Lagoons -
"'Holdih Ponds i Solid Traps
�s
�; ❑ Non -Laver ❑ Non -Dairy
❑ Other _
M Total Design Capaciy _ -
:Total,SSLW
- ❑ Subsurface Drains Present
' _ ❑ No Liquid Waste Manaeemei
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SpiIlway
Strtcture I Structure 2 �� Structure 3 Structure 4 Structure 5
Identifier: 1°f * C
Freeboard (inches): Sd 5�
05103101
rav F� ield Are
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes 10 No
❑ Yes
XNo
❑ Yes
Structure 6
tVNo
Continued

Facility Number: #31— Date of Inspection D 3 2
5. Are there any immediate threats to the integrity of any of the structures observed?. (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
$. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes f`-' 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 applicatio ? ❑ Ex essive Ponding ❑ P ❑ Hydraulic verloadn ' ! }❑ Yes // No
12. Crop type 1,i lI l� W%{
13- Do the receiving crops differ with those desiViated in the Certified Animal Waste Management Pan CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes j/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 JNo
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? X
(ie/WUP, checklists, design, maps, etc.) Yes ElNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes VINo
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 O(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application.) ❑ Yes 10
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes P(No
24. Does facility require a follow-up visit by same agency? El Yes A No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer ;to ques4o t #) Explain any YES annswers and/per: anfrecommetedatloas ar any;ather comments.
. � er
Use drawings of facility-ta better ezplatn situations (use addrnona[ pages as necessary) v Field Conv ❑ Final Notes
;❑
7 4 r- F�_Rs-r i c0 %�ou sFn r fi� / 40
16
G��rp of r-� 5 _5 Akj� FQ 5 s9 r t'Lf r-E
_ F �lw� a� �, CO.
L ow L� {�2Pr N rt
O /,j 1�Fry1✓f-� ��� MG aorJ #.3.
- ��I�✓-f f /Vff05
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: lC
05103101 f Continued

4
Facility Dumber: 3 — Date of Inspeclion r�
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 1!J 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 /Z1 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 FN, o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes /❑ No
Additional Comments and/or Drawings:.. -
a
U /lff0 DU�,
/1/ eO
5�r�lk'7- P2 140
qNo FL �i� 7Z /W .
-7s,//'/V2-
0��-
Q� % nis�AG % � ��GG. ��r/�l/FjL �✓�1-.�,o /rf�i �F
05103101
/V � ` /' r/Fie i fi��G /vGSF_ GN O��FiP• �XG`i��f Or ,2 /�OriD �,,c,..�/,e�

N _ _
# x<TiS18n OIf Water s 3
* x
Q vo> i of Soil andWat r Coacet�vat�cin
O t?ther A y:
e�
g
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit- A Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: • -3f�
Q Not OperationOperationfil 0 Below Threshold
#Permitted
[3 Certified [3 Condition y Certified 13 Registered Date Last Operate r bove Threshold: ._..
FarmName: .. j1. . �..� ................................................---..........-•----................. County:..............---.. 1� 1�................ � .._.....
OwnerName: ........... ..... Phone No:..........................---•-••-•---•................................................
...................
Facility Contact: ..... !�.✓.1...�............ ........ / Title: 6fll!J..`.Yl...t:.......... Phone No:...................................................
............. .......... ........................
MailingAddress: ...........................................� ! .............................................�.......................................................................... ........................
.. ,�/J II J� /�/
Onsite Representative:..��,-it[�.....................`� ......�.Yl r..... .`.I .....l..l Integrator ............� .. ...6�.....yl.{.(....��..._
Certified Operator: ................................................... ............................................................. Operator Certification Number: ..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude
Design Current Desi Current gn Design Carsent
Svme . Capacity Population Poultry Capacity Po ulation Cattle Ca act :-; Po motion .,�
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Ig SOO ❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean -
❑ ❑ Other Farrow to Feeder
❑ Farrow to Finish Total Design Capkio
❑ Gilts
❑ Boars Total SSL- W
—' Number of Lagoons - ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 SoldTraps - ❑ No Liquid Waste Management System
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)
- 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
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
WTo
❑ Yes
1No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 1V0
Strut "re I Strucgre 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: .... ................. ............................. ....................`.I..5........ .................................... .................................... ....... .............................
Freeboard (inches): Z' 3
5/00 Continued on back

Facilit ,Number: Date of Inspection r Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures obse ed. (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or �_/'
closure plan? ❑Yes No
(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? f4Yes ❑ 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 ❑ Hydraulic Overload ❑ Yes o
12. Crop type '�1 S G C � 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?
h) 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?
E.l.�10'*44itoris:ot' clef ciencies ire potted- OtWifid this;visit: - Yo.W.Will-receive Rio' further ; ;
rories• oridence: about: this :visit:. .. .
[-]Yes )No
❑ Yes &1_To
❑ Yes o
❑ Yes o
❑ Yes �CNo
❑ Yes 4NO
❑ Yes 0
❑ Yes`o
❑ Yes T
❑ Yes 1� No
❑ Yes A No
❑ Yes o
❑ Yes✓010
[-]Yes �fNo
❑ Yes 'IF31No
0"ments (refer to question #): "Explain any YES answers and/or any -recommendations or.any other*comments.
TUse,drawings of facility to better'explam situations". -(use addiiionalpgges as.necessary):
rf if_ i� S G .LSf LcJY,� et1Pe7lc
w
Reviewer/Inspector Name r le (fy oty,p
Reviewer/Inspector Signature: _ �-- , 'n/J//pyl, 0 Date: 1 5100

JFacdiV Number: — Date of Inspection 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 at/or below ❑ Yes o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yeso
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [(o
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 ONO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes *-01-.
o • omments nn or rawmgs - _ V
L
5100

Division of Soil and Water Conservation Operation Review t � r
h Y s a
r 01}ivision of Soil and Water Conservagon Compliance+Lisgecfi+n '�)
x
..
, is10 of Water Quality -Compliance Inspection - } x
Other A enc O "rahDm eview=�
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review �Q'Other
Facility Number ] Date of Inspection 1-7
Time of Inspection J© 24 hr. (hh:mm)
0 Permitted 0 Certified [3 Conditionally Certified © Registered JE3 Not Operational I Date Last Operated:
Farm Name: ......t
U .............C...........�rw�................................. County:........... rI t ?jl............................. .........
Owner Name:....YY.1.L?..L.1..4.' Phone No:....../� "IIrP'......................... ........ ..... .....
Facility Contact: ret1Y i(D.............1.............. Title: ... D....................... Phone No: .........................................
Mailing Address:
Onsite Representati
Certified Operator:
Location of Farm:
..........................................j.../............................�....../../...............
rator . .........
Operator Certification Number: ..........................................
Latitude • A 14 Longitude 0 4 66
Design-.. Current' Design Current `;:'DesignCurrent _
Swine ;- Capacity Population Poultry Capacity Population ; Cattle ,_ _ - ;.Capaci ' Po uladon
ElWean to Feeder ❑Layer ❑ Dairy
Feeder to Finish 4&0 1[] Non -Layer L 1 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design° Capacity.:.
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
w. Holding Ponds /; Solid Traps ' ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b, If discharge is observed, did it reach Water of the State'? (If ycs, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (Ifycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure'-) Structure 3 Structure 4 Structure 5
Identifier: D�1' ✓G 3
Freeboard (inches): 9 .............. r :!a�• I?C� n .............................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
❑ Yes X No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes Rf'No
❑ Yes O(No
Structure 6
❑ Yes XNo
Continued on back
3/23/99

Facility Number: — Date of InspectionIft
/S
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?
❑ Yes
5�No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
ZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
iffNo
}paste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
X[No
11. Is there evidence of over a plication? ❑ 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
6�(No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
E�No
b) Does the facility need a wettable acre determination?
❑ Yes
U(No
c) This facility is pended for a wettable acre determination?
❑ Yes
M14o
15. Does the receiving crop need improvement?
t9Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[iNo
18.
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.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
9No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
WNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
4No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
6ZNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
o-yioiali6tis:or- deficiencies arc n od diWing 4bis:visit: ;Y:oir Will•>�&6*4y Rio f'ukth$e
correspondence. about. this visit:. ... • • ..
F
Comiinents (refer to question #) Ex Aain'any'YES answers and/or any recotiimend'atrons or'any: other comments: r
Use drawings of facriEty to better;explain situations (use -additional pages asinecessaryj<
,Spi-iGJ%' S • Gi} P.
�t e� -� ��« G I-- Gam.
its i h 64 Ca�IS r � iYr 5 roc lad
s � r I .
Reviewer/Inspector Nam r 41—
f�/ 34
Reviewer/Inspector Signature://I / Date:

Facility Number: — _�[, I Date of Iuspection i
Odvr Issues u �T
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes VNO
liquid level of lagoon or storage pond with no agitation? l�
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 311,10
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ZNO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) []Yes 'R-No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes to No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes FTNo
Additional Comments an or- rawrngs:=
oD�t ho t P
�10
AL
rI

FFacility Number 3 $ Date of Inspection 10 2.?
Time of Inspection JS 24 hr. (hh:mm)
® Permitted [3 Certified [] Conditionally Certified [3 Registered JE3 Not O erational Date Last Operated .
Farm Name: DO CA �) e- C Fct I- '"a County: �U 1'0
............
Owner Name: .............CG�r d 1.1 Co r ./ a Phone No:.............................................................................-.........
Facility Contact:..............................................................................Title:....................... . Phone No:
MailingAddress: ..................................................................................................................... ............. .................... ..........................
Onsite Representative: �Yt'latt GZ Integrator: G d & oro
....... ............ ..................................................... g................................. ......................................
Certified Operator: .............................................. .... ............................................................. Operator Certification Number:..........................................
Location of Farm:
t.........................................................._.......................---------- ...---------- ........._.................
��i
Latitude Longitude • �° ��=
Design Current '= -
Swine Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design. Current Design Current
iulEry Capacity Po+elation "Cattle-. Capacity Population
F Layer ❑ Dairy
`Number ofLagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding -Ponds / Solid Traps ❑ No Liquid Waste Management System -
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at:. El Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -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? [I Spillway
Identifier:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
I -] Yes❑ No
❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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
Continued on back
•.,K,
3/23/99

(Facility Number_. s ] —$6 Bate of [nspcction
JO
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure 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?
9 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
IL 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
JffNo
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
Ot Rio yiolaWhs toe- deficiencies •were potted• diiririg this:visit.' • Y:oi.t will-recd*ce Rio (further • ; -
,corres�ondence. abaut� this visit ' - . .
Qomments (refer to question #) ,Explain,agy YES answers andloe any recommendations of any other cottiments ; s
Use- drawings of facile fo-better ex :lain;situs use.addih ationPages
_ w
w
. ` additional a es as necessa` - - -.,
6. Vlas4e was obServeCt rvnn;4-i� 40LV rtf �i'�G� i� S,Ora Id.e(pt WhCr6 A,
ra iv► C./.-s on Dirt . LJA54e �A nt lad �ie10� d1vo 10 ber&
Irked an;�-e �c r�sen� -�v
�
arour,4 J-r,eiA� Can a,n WaS t.
OnS;k re rP_5an+jj; , C d i sceA c:2;j)me4f
e
`�� end �e d 1°
geld ih afeD► 4W �Rs�e Was cD�jct��n9 �IJ��her nod ►n Coq
t�- S-�ef5 SkC1Lje1 6� keh 4o i rcven f fee-)A�Vd
Glad rV n D1_r d r;nJ nJ�
Vulvae s ra ���.n w ;s-}a be, to A;n sc�;�4 field :,q Mcar-tviur
Reviewer/Inspector Name ( k ae�/ti r� 7 .i C9jo1 S' 3R
Reviewer/Inspector Signature: Date:
3/23/99

.Division of Soii and Water Conservation - Operation_ Review"=
Q Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality-- Compliance Inspection
] Other Agency -•Operation Review;
r-
Routine Q Com taint Q Follow-u of DW ins ection Q Follow-up of DS«'C review Q Other
Facility Number � Date a{'Inspection
Time of Inspection ® 24 hr. (hh:mm)
APermitted © Certified © Conditionally Certified © Registered 1103 Not Operational Date Last Operated:
Farm Name: CT �.....�"........................... County:
...... .............�1v
............... ......................
...
........ ..............
.
c[ % L -� r
.......A........'A.>..
Owner Name: ...r�✓!rC.....-.................................................................. Phone No:..(..1 C7J.~.4`.......................
Facility Contact : ............... .............. Title:.................. ........ Phone No:...................................................
MailingAddress:..................................................................................................................... ...................................... ..........................
... ..... .........................
Onsite Representative: .t" t� Intehrator' ......... s..........................................
..... ..... .......... .......... ...............
Certified Operator: .................................................... — ................. ...................... I ......... ­ Operator Certification Number:..........................................
Location of Farm:
................................................................................................................................................................•----..................................................... ...............................................
...................................................................................................................................................................................................................................................................
Latitude 0 t " Longitude • 4 "
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
VC)C
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area JEI 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 (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. li'discharge is observed, was the conveyance man-made"
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If dischargc is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier: u
Freeboard(inches): a `...........................................................................................................
❑ Yes WNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
9No
❑ Yes
9No
7-7
❑ Yes Ix No
Structure h
1 /6/99
Continued on back

Paciinty Number: l — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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 pact of the waste management system other than waste structures require maintenance/improvement?
9_ Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over appl ation? ❑ Ponding ❑ Nitrogen
12. Crop type l-r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application'? (footprint)
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? (le/ 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 certified operator in responsible 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?
G No.vialations or deficiencies .were' noted durink this visit:. Y-titi�ir.re-ceive nar further .: .
correspaidenee:abbiifthis visit.: :: :: ; :: ; : ;
............................................---.......
❑ Yes kNo
❑ Yes KNo
❑ Yes NfNo
❑ Yes N(No
❑ Yes EVNo
❑ Yes W No
❑ Yes Nf No
❑ Yes kNo
❑ Yes kNo
❑ Yes 9No
❑ Yes allo
❑ Yes XNo
❑.Yes )� No
4 Yes ❑ No
❑ Yes JkNo
❑ Yes t No
❑ Yes 0 No
El Yes nNo
❑ Yes tONo
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_neci`ssary):vj
37— '4750 _�+ITJA
Ve
Reviewer/Inspector Name
Reviewer/Inspector Signature: ,� � ( —���� Date: Og f • / [ f_ 1/6/99

Division of Soil and Water Conservation [] Other Agency
Division of Water Quality
Routine O Cont taint O Fallow-u of I)W ins action O Follow-up of DSWC review O Other
Facility Number
Date of inspection �'
Time of Inspection : GO 24 hr. (hh:mm)
CJ Registered 0 Certified © Applied for Permit COermitted 13 Not O erational Date Last Operated:
Farm Name:..... : ... .. �.' t - `1..... County: t.\ ............................. .......................
. �.� �! t TSB
Owner Name: ................................ Phone Vv:
Facility Contact: .............................................................................. Title. ...... Phone No
Mailing Address: Po 1�\pS.�?...�.�`� .o ............. .........................,
...............................�-.................
..................................................
Onsite Representative: ... ...........�............................................................................. Integrator:-... .. ......................... ........�.
.........---
Certified Operator................................................................................................................ Operator Certification Number.................--...
Lgmtioq of F
7t.... ............. Y.............:+................................................................................................................r........!!....................
�.., ...kit.... GEC. �.. ... ... .. ... ...
Latitude " Longitude 4 0 fL
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes Wo
2. Is any discharge observed from any part of the operation? ❑ Yes M�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes MNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes UNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes 'ONo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes 'RJNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes'XNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes jKrNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes JKNo
7125/97

1 acitity Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes �fNo
Structures Lagoons Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 1?fNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ...... .....
r7
Freeboard (ft): ............. 11 g
10.
Is seepage observed from any of the structures?
❑ Yes
ONo
11.
is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
V[ No
12.
Do any of the structures need maintenancelimprovement?
❑ Yes
WNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
IXNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
(No
(If in excess o`f_WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ... .5.1.(..�� ¢.................................. ..............
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
C`No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
1X No
18.
Does the receiving crop need improvement?
KYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
t%No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
XYes
❑ 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
[&No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®,No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
0 No
0 No.violationsor de�tcient:ie's.were-uated-durin� this:visit. You;will receive uti further
:�:�ctirrespondei�ceatioufthis:visit:�::�.::•.:.:.:......-:�.•:�:-:•;-:�:•:�_� -:�::•;:-:�.�:�
t� ` Q r— 1�-� R<-� 5 .� t-t� l^ �►- �6 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
M

MIX
❑ DSWC Animal Feedlot Operation Reviews
ri
®DWQ Animal Feedlot Operation Site Inspection
Routine OComnlaint O Follow-un of DIVO inspection O Follow-un of I)S11'C review O Other
Facility Number 3 SCo
Registered 91 Certified `© Applied for Permit 0 Permitted
Farm Name: ....... �Q.4L.... CTv' rifts .......................................................
Owner Name:
Date of Inspection
Time of Inspection I Y1.4f) 1 24 hr. (hh:mm)
Not Operational I Date Last Operated:
County: `
Phone No:..�.9��.iar�$'.(aka............................
Facility Contact: ......irYn3.�.....Co. Title Phone No: ��
.......................... ........L]1..&I.................................. i...iGrS -.later........
IMailing Address: ......... V.0... Qx.... lgZ.............................................
Onsite Representative:....... U�......... .Yyl�fi"y`ly�.� �.................
Certified Operator s..._.�%i oA ......ar".1..1...... tw.�&.....................
Location of Farm:
............................. .......all.f a...i..N.ee..........................................x..:33xs......
............................. Integrator: ........ &101axw .... ............
.........................
Operator Certification Number, .... IgZ5. .......................
.....Q3...r+- fr.. ..... n-�.....VUV- U15,011A........ urrN-, 1.E.... ... ...... V=....�rt�!�.... �>~.....SR ..i �-..... �-,�,...a�.....
....Or.....x�arAk .5tia ......1 .e... �-�....................... .. ... ...............................................................................................
Latitude 35' • 1ZO CL Longitude • ®` EK] «
Design. Current
Design Current
Design,. • Current"..
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
[� Feeder to Finish
I y
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
12.t Teo
❑ Gilts
Total SSLW
17719an
❑ Boars
=:Number of Lagoons I Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes allo
2. Is any discharge observed from any part of the operation? ❑ Yes M No
Dischafae originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify, DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gaL'min?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ) ❑ Yes IN No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes tZ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 1PNo
5. Does any part of the waste management system {other than ]agoonslholding ponds) require ❑ Yes 0 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ;4 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 50 No
7/25/97 Continued on back

Facility Number: I — _4r(o
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 10 No
Structures (La oohs Holdin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?. ❑ Yes §d No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ............ ................ ................. ...................... 3......................................................... I ............... ........
...................................
Freeboard(ft):............11................................ ,.`............ ...............z.............. ................................................................. ...........................................
10.
Is seepage observed from any of the structures?
❑ Yes
® No
IL
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
KNo
12.
Do any of the structures need maintenance/improvement?
U) Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
B.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ISNo
Waste Application
14.
is there physical evidence of over application?
❑ Yes
91 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type L l .c t:.._......1csaI........................................�St'1 1.`..._�.1 Mn.............................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
1% No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
AYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
IN No
20,
Does facility require a follow-up visit by same agency?
❑ Yes
NJ No
21,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
22.
Does record keeping need improvement?
!Eid Yes
Q 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 5d No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? UTYes ❑ No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes UR No
® No.violations or deficiencies were noted during this.visit.- .You.will receive no flirther
correspondence about this:visit.- .. ,
Coininents ;(refer to question #): Explain any YES ansi�ers andlo'r any reconunendattons or any other comments. �
.. �F. .. k
Use'drawmgs of facility to better explain situations. (use additional_ pages as neeessary).::
11. cooktY {.moon Wars 4 CO *(Ce; a oort; sin d be, la,aW10.
1V JC- C-�p 5Wa ,gym ��. w� �, � f4fIas.
2z. V�do sack cvj Wcs[e, cftl sis 5hs4 6y &.GeirMej 44n. S pecA S1,000
be �� b "rt yujrAcr txN..t� ��a� rulnber, r,. ah 1rrt a'4- A n+a -AkA be tr�.
24 bec,;p : n WC,4c L4 j i-LO 4-Z,or.. PjaA. 0+] i to ccr�j CJC�\'on fdcrrr. ' hOOZJJ
M"• 7125/97

Site Requires Immediate Attention:
Facility No. C�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONfi SITE VISITATION RECORD
DATE: Z 5q , 1995
. II Ti : �e t�e
Farm Name/Owner:
Mailing Address:
County:
Integrator: (� /ems
O On Site Representative:
�o Physical Address/Location:
�6 A/Cs
6
a
Type of Operation: Swine. _�/ Poultry
Design Capacity:7��
Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:,° n2, ' 3 _Z " Longitude:�Z° Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: ,5�_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or&Was any erosion observed? Yes C
Is adequate land available for spray? Yes % No Is the cover crop adequate? Yes or No
Crop(s) being utilized: { O 1 q 146ef-.S
Does the facility meet SCS minimum setback criteria? 20 Feet from Dwellings? e or No
100 Feet from Wells? (9 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(O
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 096
Is animal waste discharged into waters of the -state by man-made ditch, flushing system, or other
similar man-made devices? Yes orW If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Y —or No
-Additional Comments: --"- ne le. h
Inspector Name Sie
0
cc: Facility Assessment Unit Use Attachments if Needed.

State of North Carolina
Department of Environment, Health, and Natural Resources
Wilmington Regional Office
James B. Hunt, Governor
Jonathan B. Howes, Secretary
FAX COVER SHEET
DATE: NO. OF PAGES
TO: FROM•
CO: - CO:
FAX #: / S J FAX #:
REMARKS:
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 • Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer
e

�`FFOM SCRIQHER )4C 4.22.1996 12'22
red m
P. I
- -f,- -f' - - - . .. - . . . - - - - .1�

'yam' -¢ROM SCRIUNER 14C 4.22.1996 12:22 P. 2
1916dy
114.
----

11
State of North Carolina
Department of Environment, Health, and Natural Resources
Wilmington Regional Office
James B. Hunt, Jr. Division of Environmental Management Jonathan B. Howes
Governor Water Quality Section Secretary
Mr. Jonathan Hand
Nations Bank
P.O. Box 110
Mt. Olive, NC 28365
April 26, 1996
Subject: Farm C&C Farm
Facility: #31-56
Duplin County
Dear Mr. Hand:
The C&C Swine Operation was inspected on 9/28/95, by Division staff in order to determine
•compliance of the facility with established rules and requirements. The visit consisted of inspecting the
lagoon(s) which treat the waste from approximately 5760 swine so as to evaluate compliance with freeboard
requirements (19 inches of minimum freeboard), erosion severity and structural integrity of the dikes, the
availability and condition of an appropriate spray application site and the presence of illegal devices such
as discharge pipes. In addition, all appropriate registration/certification documents were reviewed.
Mr. Cox operation consists of 5760 swine in confinement buildings, a lagoon with 64 acres planted
with cotton, corn, and rye available for the purpose of applying swine waste. The lagoon met the
freeboard requirements with approximately five (5) feet of freeboard at the time of the inspection.
On the date of inspection, no discharge of waste was observed and Mr. Cox swine operation was
considered to be in compliance with the established rules and requirements for animal waste management
systems.
If you have further questions, please contact me at [phone] extension 207.
cc: Eric Cox
0 W iRO
Sincerely,
r
avid Holsinger
Environmental Engineer
127 Cardinal Drive Extension, Wilmington, N.C. 2M5-3845 0 Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer

•
Site Requires Immediate Attention:
l Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
` ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD i
DATE: 6-6 , 1995 �Z �
Time: 2 {
Farm Name/Owner: CG < _1 C?i✓ro 1 � G tHle_
Mailing Address: Ke'n t4e
County: (1) ol
Integrator: G�d56-q� F-r►'wt f l Phone: 1 �Cy3 7EZ3
On Site Representative- �znn, 2 6ro6K IGroSrn�,5 Phone: ZR�n�20S 3
Physical Address/Location:
Type of Operation: Swine Poultry Cattle 0 1 nq
Design Capacity: rD'•(0Q Number of Animals on Site: 51(', d
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (Yes* No Actual Freeboard: Z- Ft. 0 Inches
Was any seepage observed from the lagoon(s)? Y2es o No Was any erosion observed? Yes No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop2k s) being utilized: GY0 . be?' m LK4
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No f
Additional Comments: _ _ k)05C'5 rl�1 O 't!l 02 �I 24- nok k Wk
00 -''jr
• L . L w.i5
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
• DATE: , 1995
Time: Z
Farm Name/Owner: Corm 5
Mailing Address: 3Z r S ' G&
County: „ C6o1 i N_
Integrator: c>& � S bxn Cxt arm 5 Phone:
On Site Representative: Phone:
Physical Address/Location: 11Wu R03 6m lL"fh %0 5Vi �e� 1,e (Y% 151(a I F4 on 1 �U,
rn; . vn . r.' Ah
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
• Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
.Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS BIue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: G-•44,e 6jtecl - no one on 51'
CO l �_ no}- t n g n 2 . b h6U54e5 .
e L . L &,v k-5
Inspector Name
A" rw
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires immediate Attention
•
LJ
40
Facility Number: 3 .
SITE VISITATION RECORD
DATE: 4 1995
Owner: o Farm Name: `-
County: Gd
Agent Visiting Site:
Li
Operator: _
Phone: _110 -`17 C- I2f
Phone:
On Site Representative: Phone:
Physical Address: Q 3 6­6 '
Mailing Address:
Type of Operation' Swine Poultry Cattle
Design Capacity: G 16 D __ Number of Animals on Site: s
Latitude: 0 Longitude: Q
"Type of Inspection: Ground :2< _ Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or(9 Actual Freeboard: Feet -Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section..
Was any seepage observed from the 1agoon(s)? Yes or&D Was there erosion of the darn?: Yes o
Is adequate land available for Iand application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments: L-A {t_ A' 1 �• 6 ( F Q
'L 3
Fax to [phone]
S ianutirEr of Agent

OPERATIONS BRANCH - WO Fax:[phone] Hug 1 995 11:y38 P.18/20
Site Requires Imrnedizte Attenrion _
•
•
�j
SITE vlSMkTION RECORD
Owner: cra 1 ��,r.zr
�4`�G �`3rl7'� NaIT7e:
A e,1t isitir,gSite: _—`-� �Phone:
Operator: _ Phone:
On Site Representative-. _._._ � Piian,-:
Phys;-cal address: _ �-T2,t b �
Mailing Address: --
hype Of Operation: Swine_ f-'oultnr
Design Capacit�,/: � 7 �_b � iNumbe,r of A.nima.s On
Latitude.
-__---
Latitude:
Type of lnspcction. Ground Atrial
Circle yes Or `T-
Does the Animal 'W"aste Lagoon hiavt sufficient freeboard of l Foor + 25 year 4 Dour zm.-m evenr
(approximately' 1 Foot + 7 inches) Yes u, � �"�CL�1c11 .�cv�lfoard: _ � _ Feet lnchcc
For facilities with more than Ol?e is auri, please address ih.e oilier lagoons' L F'; k;,arG ltll �r tit
coM.;nents Sel-111011.
WLs any seepage observed fxorr� e is oon(sj'? �"4s or wa:� them cresmn ul t.Ei: darr,,,(0
Is adequat& land available for lard application? Ycs or I-;-, rs the cover crop Y. s -)r '.S
Additional Comments: _ - � � Uu�J A-1 /, 6 r f Q - - — -
t
fax tr (919) i -�s