310084_INSPECTIONS_20171231

NORTH CAROLINA
.__
Department of Environmental Quai

CJ'1)ivision of�W3.ater 1
Faeility Number L �{ O Division of Soii"and;Water Couservahon,
- Other
Type of Visit: eF Com ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: OrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f to Arrival Time: 1 y 9 Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: S�_ra (4 f Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region:
Certification Number: I ?-? o6
Certification Number:
Longitude:
Design Current =� Design Current • Design RCurreut�
. _
ra-
Swme
,
Capacity Pop r ;Wet Poultry :Capacity �Yl'op Cattle CapaeIty Pop
w
,. a � �£
Wean to Finish,I
ILayer I Dairy Cow
W to Feeder
Non -La er Dai Calf
eeder to Finish
..
c.tr- 7 � w x- Dairy Heifer
Farrow to Wean'
.,
Design Current Dry Cow
Farrow to Feeder
_
D Poultr Ca acEPo Non -Dairy
Farrow to Finish
Layers
Discharges and Stream Impacts '
1. is any discharge observed from any part of the operation? [-]Yes o ❑ NA ❑ NE
Discharge originated at: ❑ Structure El Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA [] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes EJ No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �No❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued
Page 1 of 3 2/4/2015 Continued

Facili tuber: jDate of Inspection: ID /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [i]'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 O
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 JF,�o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ICJ 1Vo ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � 10 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ED<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
&No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[5No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[DI�0
❑ NA
❑ NE
Page 2 of 21412015 Continued

Facility 1. ber: I - jDate of Inspection: c,
24. DidICJ;the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o NA ❑ NE
v
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility) If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
[ -1g7V_
❑ NE
❑ Yes ErNo [DNA ❑ NE
❑ Yes ❑ X�NA ❑ NE
❑ Yes [3"1To ❑ NA ❑ NE
❑ Yes
[3r o�o '
❑ NA
❑ NE
❑ Yes
0`Ro
❑ NA
❑ NE
❑ Yes
L__I N—o
❑ NA
❑ NE
❑ Yes
Q-TTo-
❑ NA
❑ NE
Comments (refer to gaesdati #): Explain any YES answers and/or any additional recommendations or any other.commeats
Use drawings of facility to bettei "explain. situations (use additional pages as necessary).. k.,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
'& " (( A0 --w-
Phone: 1� 17
L� l
Date:
214 ar5

i
Division of Water Resources
Facility Number - �--� ,- f---' 0 Division of Soii and Water Conservation
0 Other Agency
Type of Visit: C"�om��pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
[Zeason for Visit: (-')Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O Departure Time: L_J County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / L Title:
Onsite Representative: _ L -�� f T 9(-9
Integrator:
Phone:
Certified Operator: Certification Number: r 7 3 (J 6
Back-up Operator:
Location of Farm: Latitude:
Swine
Wean to Finish
W n to Feeder
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer I I ��]
liry roultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWIZ)
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 ONo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE,
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
[—]Yes
NA
❑ NE
❑ Yes
No
0 NA
❑ NE
Page 1 of 3 21412015 Continuer)

a
Facili Number: 31 jDate of Inspection: p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
; No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
D No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ff No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yesff
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public stealth 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
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs - ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ff No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ZrNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ;:�JNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a tack of properly operating waste application equipment?
Rea uired Records & Documents
❑ Yes �o ❑ NA ❑ NE
❑ Yes [,_J.AIo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [2"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ 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 ETNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3'No ❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

Facili Number: - Date of Inspection: '
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P-lq—o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ETN ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E7KA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead 'animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[; "o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Ca<o
❑ NA
❑ NE
❑ Yes
LLJ No
❑ NA
❑ NE
❑ Yes [;�'No
❑ NA
❑ NE
❑ NE
❑ NE
iComments (refer to.question #):.Explain any YES answers and/or any additional recommendations or any other comments.. I
Use drawings of facility to better explain situations (use additional naves as necessary)
F%r l,-- //c r- or C S
J" Ir9_pI-
Reviewer/Inspector Name:
Reviewer/Inspector Signature: a
Page 3 of 3
Phone: J(0 % ? i % Jp y
Date: Q f Asr// b
21412015

• ' NJ Division of Water Resources /
. Facility Number ©- O Division of Soil and Water Conservation 1/
O Other Agency
Type of Visit: 0 Co ance inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: % / ArrivalTimed 17S0TDepartureTime; ® County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: II Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
)Mean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number: �7 30 6
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I I ]Layer
Non -Layer
Pullets
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? (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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes B<o ❑ NA ❑ NE
[] Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes No ❑ NA ❑ NE
D Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili umber: jDate of Inspection: Z
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): S 5
4�
Observed Freeboard (in): 4 3" t[
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [fN ❑ 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 EjN0 0 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
[INo
❑ 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
[! No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�
f'J No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
-E!�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 E?J'No ❑ 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 I__I "o ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑ Yes WNo
o
❑ Yes
❑ Yes) o
❑ Yes rNNo
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 [ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ff No ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

laaciliNumber: -3 IDate of Inspection: 2
f
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ENo
❑ 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
ENo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ A ❑ 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
E No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
"No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
El❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
/ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rNo❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers -and/or any additional°recommendations or, any other comments ;
Z,,
Use drawings of facility to" better�eiplairi situations, (use additidnaCpalles as necessary):
L Po � goo �
L��oo
�e Sy`r 1 z5. S �� �•-".e Sow r
� Z l� �{ 1.r-
4-9 S � � �' � Ck
/� q
L �� �
rv� r �a 90 '~ ` i_ a
I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ill
Phone: 910 V G 736p
7
Date:
2/4/2QI4

" 'Division of Water Quality
aFacLUv Number -1 87 / 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: AD Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assi Wee
Reason for Visit: 4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: Departure Time: County: �ilRegion:
Farm Name: �.j s�f r� . _�',% /Y1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
J
Onsite Representative:
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number: 0 b o'?G
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.
La er
Non -La er
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Cattle
Design .. Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P No ❑ NA ❑ NE
[:]Yes
iio
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesFNo
o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [3 Yes ❑ NA ❑ NE
of the State other than from a discharge?
1
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jo No
a. If yes, is waste level into the structural freeboard? ❑ Yes ONO
❑ NA ❑ NE
❑ NA ONE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 21 -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 5No
❑ 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 ZfNo
❑ 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 A No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes PNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 26No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [_ ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [:2No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [;3'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 �allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ SIudge 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 ryhlo ❑ NA ❑ NE
.-' 'TT
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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
[?I No
❑ NA
❑ NE
❑ Yes
VI No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes [% No ❑ NA ❑ NE
❑ Yes lam"' No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes P No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [—]Yes [;TNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes C;rNo ❑ 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).
1,-7y
t4 �a/IZ'
I
o. 7-7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
coy-ds too)C r-�tj
Phone:,
Date: %
21412011

ivision of Water Quality
Facility Number Tj - ® O Division of Soil and Water Conservation V/
O Other Agency
type of Visit: Ptompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: erRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: c`7 1 17 Departure Time: County:
Farm Name Gio 10Lk Ce ry7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact: Title: Phone:
Onsite Representative: 64e(AMa I CAM A J Integrator:
Certified Operator: Certification Number: Q =01
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
I Other
Other
Discharges and Stream Imnacts
La er
Non -La er
Other
Poults
Design Current
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
[:]Yes
rNo
T
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
ZNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
allo
❑ 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
JZNo
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
;2rNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[3"No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection: 2-1 9
W ste Collection & Treatment
4. s 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
C No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 12- f�> 3 --P,,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ 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
[�j 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
qNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E21To
❑ 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 ARPlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
[;�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑�10
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
eNo
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
)allo
❑ NA
❑ NE
Renuired 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 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.
[:)Yes [�:„No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections. ❑ Monthly and 1 ° Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes E] No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,rNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facitity Number: - Date of Inspection: 2
24.. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;2 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
DI�o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
'P
Wo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes JC2'+No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes PNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes P'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).
kA_ N
1,2_I z f13 I.q�
1 • q1 Z
S «1/ 3 1, 2g5 c
1,00 z.
/23113 . sC
<< `y Z
11301I 3 /. r I
1. 7 If Z
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
❑ Yes [;no ❑ NA ❑ NE
❑ Yes VTNo ❑ NA ❑ NE
❑ Yes [;hfo ❑ NA ❑ NE
❑ Yes ,, ,No ❑ NA ❑ NE
j Fa rm d- rl- car ds 1001054-o'd,
0l Phone:
Date: Z l l3
21412011

U✓ Division of Water Quality
Facility Number 0 - L �! _J O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit�Routtiine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I "7 jib I i-L.} Arrival Time: IOl]a Departure Time: 1 'ti6o County: Dy&Z�j Region:
Farm. Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �T�t..sa� S-Aft.-uo Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Latitude:
Phone:
Certification Number: d ' _
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L,
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:
Design Current I
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[—]Yes EA No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
i�No
❑ NA
❑ NE
/No
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: ► -Y Lf Date of Inspection: or , qi jY
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L ,Q_ 1-AG-owd %
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1�1 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 [Z/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 [ yNo ❑ 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 �(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 ffNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EJ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes U ❑ NA ❑ NE
❑ Yes L Zo ❑ NA ❑ NE
❑ Yes D<o ❑ NA ❑ NE
❑ Yes L.E7'Yo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EfNNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Qio ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jfNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. IS;khe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[—]Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes To ❑ 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 ZNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [�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 ZN(o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 214120 1

-Division of Water Quality
^ Facility Number
IO Division of Soil and Water Conservation
— 0 Other Agency
rof Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: s3 l Arrival Time: 'f parture Time: County: Xw Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r Titl Phone No:
Onsite Representative: Integrator: ,'%7 1�
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: c = 6 = « Longitude:
Design Current Desigu'= Current Design 'Currenf"';
Swine Capacity Population Wet Poultry Capacity - Population '_� Cade " Capacity P,opulati4ne
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ 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?
❑
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 ,mil No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[INA
❑ NE
ElYes
WNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3 — 62ZI Date of Inspection 3
Waste Collection & Treatment ,J
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes YJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes VNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 9-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .3
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 ;ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation Ooses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ;dNo ❑ 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 (;fNo ❑ 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 PNo ElNA ❑ NE
ElExcessive Ponding ElHydraulic Overload ElFrozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
.0
XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
V No
❑ NA
❑ NE
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
P No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any::other comments "
Use drawings of facility to better explain situations. (use additional pages as necessary)
re WdS /00 jfiea 7,
Reviewer/Inspector Name fir/ n 4 Phone:
Reviewer/Inspector Signature: Date: ,-2 5
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q(No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes [ZNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PrNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
eNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JVNo
JYNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2TNo
❑ 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
P'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
dNo
❑ 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
'VNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JeNo
❑ NA
❑ NE
Additiohki-Comments and/or Drawin s
,,/
?
1,3
L 2
ql qlld
1. p
��y icy
;'0
L
Page 3 of 3 12/28104

Facility Numher
'Division of Water Quality
O Divisionbf Soil and°Water Conservation
D Oth6jr,A2enev'._
L
f Visit O-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: / 7 60 Departure Time: �.l County: G ��� Region:
p
Farm Name: �`� �- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
7
Onsite Representative: -/-12cZ,� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o =' = « Longitude: = o
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
'Division of Water Quality
O Divisionbf Soil and°Water Conservation
D Oth6jr,A2enev'._
L
f Visit O-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: / 7 60 Departure Time: �.l County: G ��� Region:
p
Farm Name: �`� �- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
7
Onsite Representative: -/-12cZ,� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o =' = « Longitude: = o
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ECITurkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes]
i
No
❑ NA
❑ NE
12128104 Continued

Facility Number: ,; —� t 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 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes DdNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes � No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EfNo ❑ 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement? (((
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )2�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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)
U. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
21N o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES -answers and/or any recommendations or any other comments _
Use drawings of facility to better explain situations. (use additional pages as necessary): '
Reviewer/Inspector Name _ Phone:
Reviewer/Inspector Signature: oo'Date: Q
1,2/28/04 Continued

Facility Number: �j — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[a No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�TNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
qNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
VNo
❑ 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
W(No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
QNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JZNo
❑ NA
❑ NE
5 �KIly
t ,,
12128104

on off Water Quality
Facility Number 3 # �0 Division of S0�i and Water Conservation
Q OtherAgency
W
Type of Visit Qr_C,.00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit,, Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1017 //P /W Arrival
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
" C e arture Time: County: A 71111--Region:
�Zvlx_i`Cl/��Y% Owner Email:
Facility Contact: I
ZZ.
Title:
Onsite Representative: ��-
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phon No•
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = = i Longitude: = ° = 6
p g V. p Wet P,oultr . p g tY . ,..P.R�4'Capayl'op la one
1?esi n Current Design Current Desi Current
Swine Ca ac�ty Po ulatian y Ca aci Po ulahon.� Cattle t'
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
_Dry Fopltry
❑ 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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
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 gNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes A No
❑ NA
❑ NE
❑ Yes 0No ❑ NA ❑ NE
12128104 Continued

`Facility Number: 3 — 6L Date of Inspection Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �VNo ❑ NA El NE
a. If yes, is waste level into the structural freeboard? El�Q Yes No ❑ NA ❑ NE
Struct e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): .40
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes )JNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes PNo ❑ 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 JZ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ON. ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ;KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect 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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Pf No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
gNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J�2(No
❑ NA
❑ NE
Comments refer to question # Explain any YES answers'an&or any recommendations br- an other com nents�
Use drawings of facility to better explain situations. (use additi©nal'pages=as necessary) w
r : yy
Reviewer/Inspector Name v '- i y`a/ Phone: `f111 :2,4 L/
Reviewer/Inspector Signature: ` I Date: 16 O
12/28/b4 Continued

a=
Facility Number: 3/ — t Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ,
the appropiate box. ❑Yes � No El NA ❑ NE
❑ AMP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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
VNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the pen -nit?
❑ Yes
E No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VfNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
k�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2rNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EdNo
❑ 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
VNo
❑ 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
UfNo
❑ 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
dNo
❑ NA
❑ NE
12128104

J
�. Division of Water Quality
Facility Number $ 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit -0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit,,�Routine o Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
A Q -late of Visit:
,V
arm Name:
CP
Owner Name:
Mailing Address:
Physical Address:
KIArrival Tine: Departure Time: County:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
�o
Latitude:
Back-up Certification Number:
Region:
=" Longitude: = ° = ' [=] "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
4%
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: El
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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
12128104 Continued

Facili Number: 31 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ErNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes UNo
❑ NA ❑ NE
Struce I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2rNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes J'No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes/J] No
ElNA NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes� No
❑ ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ YeS , F,,fNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes '-No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes EfNo
❑ 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 C�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo []NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
CaRo
❑ 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
�allo
❑ 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):
' P /'n7l r� Or s
Co
Reviewer/Inspector Name K � �Gr.-.�� Phone: rw—
Reviewer/Inspector Signature: Date: r�G
12128104 Continued

t
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 23'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;3 No ❑ NA ❑ NE
the appropirate box. ❑ WIJp ❑ Checklists ❑ Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
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
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?
Additional Comments and/or Drawings:
r� 3
/U /3lot,, 04 JD
0
rr
❑Yes PNo
El NA
[I NE
❑ Yes PIqo
❑ NA
❑ NE
❑ Yes B'No
❑ NA
❑ NE
❑ Yes J'No
❑ NA
❑ NE
❑ Yes ONo
❑ NA
❑ NE
❑ Yes Jallo
❑ NA
❑ NE
❑ Yes [,-J'No ❑ NA ❑ NE
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes L/TNO ❑ NA ❑ NE
❑ Yes j"No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
12128104

Facility Number
Type of Visit
Reason for Visit
Date of visit: li/�
Farm Name: `_�
Owner Name:
Mailing Address:
Physical Address:
�V Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
LArrivai Time: I
" ri ( Departure Time: County: Region:
�� Owner Email:
Facility Contact: Title:
Onsite Representative: .2 1_ _r -
Certified Operator:
Back-up Operator:
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
Phone:
Phone
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = A ❑ Longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
Type of Visit
Reason for Visit
Date of visit: li/�
Farm Name: `_�
Owner Name:
Mailing Address:
Physical Address:
�V Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
LArrivai Time: I
" ri ( Departure Time: County: Region:
�� Owner Email:
Facility Contact: Title:
Onsite Representative: .2 1_ _r -
Certified Operator:
Back-up Operator:
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
Phone:
Phone
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = A ❑ Longitude: = ° = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood CowL
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
4!lNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Cg.11ecti6n & Treatment
4. Is storge capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes J�!I'NO ElNA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Strut e l Stru e 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [--]Yes o No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [--]Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes YJ 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
j2No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
QNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,rNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Jallo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PTNo
❑ 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):
Ir
/1001 51-ea
Reviewer/Inspector Name (1t t/ T Phone: Q< L 7�[s� " ,9760
Reviewer/Inspector Signature: % — Date: s �r aOOS
Patre 2 of 3 1128104 Continued

Facility Number: — Date of Inspection a
Requi Eokecords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P'No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P'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 -'0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
[I NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Fe]"No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
.rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
p No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑'No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,�{
.f1 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
G'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
ri
6 Cl) �• 3
Cad `r 8
Ca) 1,6
old-310Sr (/) /, 7
- Ca) 1..3
GlSec/ A 7
,�irauy
ti X!>'CZ�7h c4L-,
Page 3 of 3 12128104

Division of Water Quality
Facile ty Number 3 O Division of Soil and Water Conservation '
O Other Agency'i
Type of Visit 01 oompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4E Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 'y/
Farm Name: "_�
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: Region: 4 lt4
Facility Contact:Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ e ❑ 6 = Longitude: 0 ° ❑ 6 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other - - - - - - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
El Turkey Pouets
❑ Other
Discharges & Stream Imparts
1. Is any discharge observed from any part of the operation?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RfNo
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
12128104 Continued

Facility Number"Number"3 Date of Inspection 7 G
r
Wq,Se Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;il�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: / Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ZNo Cl NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes Z1 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes .2No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes pNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JZ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
;2No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes
❑'TVo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Eno
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Comments(referto questioni#} Ex}ilatn any YES answers$andlor$nyr�ommendafitonsory other comments.
Use drawmgs f faciLty to better explain situati©us. (use a�ddn rtioal,pages�as�neeessary} R
OF
Reviewer/Inspector Name IPhone: lf7 ' yx
Reviewer/Inspector Signature: Date: y 7
12128104 Continued

Facility Number: 3 — Date of Inspection
Reauked records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;2No ❑ 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 El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )21qo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2rNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
.'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2No
❑ 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
;301-4o
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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
RNo
❑ 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
ONo
❑ 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
,rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by saute agency?
❑ Yes
e No
❑ NA
❑ NE
Additional Comments and/or Drawings:
k- 1C_ 5
\/our
12128104

ivision`of Water Qpanty-,
,O�Divrsion ofSoil and Water Conservation
Q.Other Agency
_ _
Type of Visit grCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time: '
Facility Number bi�O Not Onerational O Below Threshold
13 Permitted 13 Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ...t.t. C• .. s�. Ts Q tE II..hEr County: £L.. ..... __ ...... _---- ---
OwnerName:........................................................................... Phone No: ... ................................ .. ...... ..........
w............
Maihng Address:
FacilitvContact:....--•------•----•-•----•-•-•............................................... TRI :......... I.. ....... ......... .......... ..... Phone No:
Onsite Representative: ••,, integrator•
Certified Operator: Operator Certification Number:_.. ... _....... �.....
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • < «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
4
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 )?fNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes <o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ANo
S7cture I Structxre 2 Structure 3 Structure 4 Structure 5 Structure 6
Freeboard (inches): `7
12112103 Continued

Facility N' er: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
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
12. Crop type
13. Do the receiving crops differ with those designated in the Certified
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?
Odor Issues
Waste Management Plan (CAWMP)?
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
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 ;?40
❑ Yes "FeKo
❑ Yes ,8 No
❑ Yes �No
❑ Yes '10<0
❑ Yes No
❑ Yes ,ONo
❑ Yes JONo
❑ Yes .Pto
[I Yes 0No
❑ Yes 'O`No
❑ Yes P'No
❑ Yes ❑Vo
❑ Yes .0<o
❑ Yes ErNo
❑ Yes )21&o
❑ Yes
'PXo
;Comments {refer to gin*itiorit.#) E plain any YFeS swets and/or auy recammendahons or any othe cam Gents. n:' -
3Use drawmgs.of isciltty to better earpiarn situations. {nse eddihon$I gages as nll �sary)s � Field COPY ❑Final Notes
/7/ oZX/ /4;;�Zc& c? /-P
ij-
y
Reviewer/Inspector Name r e = x s
Reviewer/Inspector Signature: Date:
12112103 1 Continued

Facility Numbers _ Date of Inspection d
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes 0140
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below_
❑ Yes �lo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 2rlL
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ed�o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ YesAfj1No
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes eo
28. Does facility require a follow-up visit by same agency?
❑ Yes O`Io
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes,R<o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
OYes ❑ No
3I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Zrlio
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes �No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ZrNo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ZNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes r
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

u•
� ,- w, � -� � �Vi51©t) Qi• WBtCC Qti�t�' �.
�' _ _ p Dririsit?n o[ soil gad, .
Type of Visit CCtompliance inspection O Operation Review O Lagoon Evaluation
Beason for Visit �u Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 - i,ate of Visit- t1 Z 1 OZ Time:L 10 !) �
Not O erafronal 0 Below Threshold
Permitted © Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: -- C 1j T � 54ewe,r } S-,r"',.`%I Fares. County: Z)
Owner Name: Ct"/4i.1` '5_4"roL-AI c J4 1 —qr0tali Phone No:
Mailing Address:
Facility Contact: Title: Phone Na: 11
Onsite Representative- C v 4' s S � o (,,of S�e>`✓u f; S D �di I ntegrator: V �� f7�d W► N
-
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' �• DK Longitude
Design .Current _ =Design Current _ - Design --,.Car rent
SwineCavacitv
Poultry acity P-ulato-Cattle
.. P© silatwn
❑ Wean to Feeder " ❑ La er Da
❑ Feeder to Finish ❑ Non -Layer If 10 Non-Dairyj
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
El Farrow to Finish Ttrtal design Capacity
❑ Gilts
❑ Boars Tot'i SSLV1?
_ Numher''.0 La'govns �( - ❑Subsurface Drains Present ❑ Lagoon Area ❑ S ray Field Area
Holding Ponds ,Solid'Traps '
�-Q ��. ❑ No Liquid Waste Management System i
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 Cl 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? ❑ YesffNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �o
Waste collection &- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes '4� No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: C— f
Freeboard (inches): S] t43
05103101 Continued

r
Facility Number: 3 ] — S Date of Inspection it 2
5. Are there any immediate threats to the integrity of any of the structures observed?-(ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?ff ❑ Excessive Ponding ❑ PAN [IHydraulic Overload
12. Crop type ,7e ✓ —t v 0k, r! a L1 , S,v ,,, vAA � ,r` u Z.¢ s1M r j 1 ..-- 11,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes A No
❑ Yes 0 No
❑ Yes VrNo
❑ Yes 0 No
❑ Yes Ja No
❑ Yes 0 No
❑ Yes Z No
r-regzd
❑ Yes ONO
❑ Yes PNo
❑ Yes JZNo
❑ Yes �No
❑ Yes ONO
❑ Yes XNo
❑ Yes 'E J No
❑ Yes 14� No
❑ Yes 0 No
❑ Yes ONO
❑ Yes ;;rNo
❑ Yes PNo
❑ Yes ,,.J �,{No
❑ Yes iNo
❑ Yes ❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comiments.(refer to gnes#iott #): IExpliiia aay 1'ES answers ancllor:aAy iecommettiifations or auy other comments`.
_
Use drawings of fa¢dtty to Better a rplata situah otis: (use adii€teoaal pages as necessary) CorvJ El Final Notes -
�❑ Field
L►ac,,LsP A end l v yooh3
R /le wei1 r-1 ok►1; cvV'epl. -Ttie ree_ae-ds qre well ke& Tt,e
'I,re L.rEll 1^'laj 461"'ned - Ya u vl ced �0 2 qn et�^.I,L ►td rnC��i �'ro,,•-�
_kr,L,�; cqd 4o allow far tlO slot b-14j s,.4,.A A".r yerkr.
r­
_r4,Hk- ye" boy ooy ef�o,�s a ma.��q�s� --�L,P ��,�,,,�► Joed Q/r�e✓.
Y
Reviewer/Inspector Name i o
Reviewer/Inspector Signature: Date: 2 Z
05103101 Continued

Facility Number: .3 ] q Date of Inspection 11 21 Q
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation? V
27. Are there any dead animals not disposed of properly within 24 hours?
2& Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31 _ Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Cotnments_andlor:Drawings:; =- r
❑ Yes ❑ No
❑ Yes ONo
❑ Yes ONo
❑ Yes 'FzrNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No
O510310I

G
a �r- D1VIStQII Of Weter 42ualitji-
e
Q -ni _-06 d 4 "d Wa r CofiiirYi�tlOII
Othel;;Ag`^''Y
Type of Visit )@ Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 3 2! o 1 Time:
Not Operational Q Below Threshold
,oPermitted E3 Certified [3ConditionallyConnditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: CrCV r�'S F 'VCw�r ,57ro� Fq,'`L Count U v I t .......-._.
............................. .......... �-..........------------------.----.----.---.-.......... y= .............�.....:1.
Owner Name: C 4l 3 SGwra? �y '"O Phone No:
r ..........................-.-.....-...-....-.........-......................_...............-..-....................................................
FacilityContact:.............................................................................. Title: ................................................................ Phone No. -
MailingAddress:............................................................................................... ...................... .......................
Onsite Representative:..4. `N.'�.1 J.�. ro !"+!....................... integrator:. m : �t ky.1. `.1 !" !. 5 ...............................
Certified Operator:................................................................................................................ Operator Certification Number:.- ..........................................
Locationof Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & 66 Longitude �• �4 it
Des Current Desi Design Current gn gn Current
Swine Capacity PopulationPoultry Capacity Cattle
capacity..- Po iikd >4
❑ Wean to Feeder JEI Layer ❑ Dairy
Feeder to Finish 1❑ Non -Layer 1 ❑ Non -Dairy
❑ Farrow to Wean
- ❑ Farrow to Feeder [3 Other
❑ Farrow to Finish Total Design, Capacity
❑ Gilts
❑ Boars Total_SSLW
Number of Lagoons .` ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds /Solid Traps I❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 9rNo
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 ,Ed No
c. If discharge is observed, what is the estimated flow in &Ilmin? h /a
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 Al No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? . ❑ Yes 'R No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier: f^v��ir ��C`V4r�
..................................................................................... ................................... ....................................
Freeboard (inches): , 7 2- 3 0
S/00
❑ Yes '0 No
Structure 5 Structure b
Continued on back

Facility Number: 3) — $ Date of Inspection 3 Ol Printed on: 7/21/2000
• 5. Are there any immediate threats to the integrity of any of the structures observed? Gel trees, severe erosion, []Yes ONo
seepage, etc.)
6. Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ,14 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 /19 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes jTgrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes jNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes P9No
11. Is there evidence of over application?
I ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload El Yes 5INo
12. Crop type eel e%-tyA4 H�'�1 1 j6erv,vAA 124 & �u ,-e ) S�,,gll G,,, 'in
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: �'Vo yiolatidris'or deficiencies wtere noted d&ifig this'visit; • Yoir will-recgiye iio further
correspondence. aboitf this'isIL
❑ Yes � No
❑ Yes ;ffNo
❑ Yes gNo
❑ Yes P1 No
❑ Yes 12�No
❑ Yes OfNo
❑ Yes ONo
❑ Yes WNo
[]Yes VIVO
❑ Yes fXNo
❑ Yes -0 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
Comments (refer to question #): Explain any YES answers and/or any recommendations or:any other comments.
Use drawuigs of facility to betterexplain situations (use additional pages as necessa =
sac % 1 1-4 nee-WA-f ave well kepi
I&
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 3 Z Q 5/gyp

i
Facility Number: 3 Date of Inspection J 2$ 0 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ 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 0No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
5100
5100

J.O-lhvrsidn of Water Quality
- ;Division of ,oil and' Water Conseriaon
e
Type of Visit (,Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: I 6- ime: � � Printed on: 7/21/2000
Q of O erational Q Below Threshold
Permitted 0 Certified Conditionally Certified ©1Registered Date bast Operated or Above Threshold: --_---
✓ -S WAyfi 7y1�� county:.....
�� =
Farm Name: ........ .... ..... ......... : .......................
Owner Name: Phone No: CN
......................................................................................................_..... ....�...-I........r�
Facility Contact: .0 �.TI.S....�.....: `'.�'""�^ ...Title 1 f lz'►�s Phone No:
....................................................................... .......
MailingAddress:..................................................................................... .......................... ............................................................................ �...�............�... _
Onsite Representative:..../k:�.... .....:N_r ._Integrator:............i._.............................................
Certified Operator:
Location of Farm:
Operator Certification Number: ..........................................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �'°°
Design Current
Swine Canacity Panulation
❑ Wean to Feeder
J;TFeeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag,»n Area ❑ Spray Field Area
Holding Ponds / Solid Traps ID 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 it observed, did it reach Water of the State? (If yes, notify DWQ)
c. II' discharve is observed. what is the estimated floe.• in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure Structure 4
�
Identifier! —a /I - /
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Structure 5 Structure 5
Freeboard (inches):
slow
Continued on back

Facility 'umber: — Date of Inspection vv� Printed on.• 7/21/2000
5. Are there any imm diate thr is to the integrity of any of the structures obse ed? (i trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes CO 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 O\No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes N0
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 ap lication?/❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type Y,
13. Do the receiving crops diffwwith thosAesignated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21- Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ 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?
violations-ok. dificiencie5 were noted-dit'ritig this:vJ. isit: Yoiif wreceive Rio: Ifui•ther ;
.............. .... .. ..
corresPoridene , agouti this vtstt_ . . . .
❑ Yes No
❑ Yes I
El Yes No
❑ Yes No
El Yes No
El Yes WNo
❑ Yes �No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes tNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any. other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�119h
• � � ('a � --fir -,� e.a� � �� �it> > �T � � �� •
Reviewer/Inspector Name L�_' � y l�j2 /1' ;"I-
Reviewer/Inspector Signature: , L `� Date- �S� l�G5/00

Facility Number: — Date of inspection QU Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge tit/or below ❑ Yes dNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes &(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes t
o
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 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes R No
AdditionaMomments and/or Drawings:
V P
G�s�;��
I ool/- s
5/00

W� Division of Soil and" -Water Conservation.- Ope hon-RevkW_
D Division of Soil and A . ter, Conservatrnn :Compliance Inspection
Diyisian of Water Qualify Compliance Inspection
Other Agency Ope on Review
Routine 0 Com laint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review
Facility Number Date of Inspection
Time of Jntipectiota
Permitted [j Certified [3 Conditionally Certified 13 Registered 113 Not O erational
FarmName: ..... ..-............................................................................. County .........
Owner Name:
Phone No: .............
0 Other
�Q 24 hr. (hh:mm)
Date Last Operated: ..........................
i- �.....................................................
.................. .......................................... I ........
..-.
Facility Contact: Title: ............................. Phone No:
MailingAddress: ......................................................... . .......................................................... ..................................................................................... ..........................
Onsite Representative:..-2.f...(..........................................................
`........................................................................... Integrator: .....
... ..
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location o£Farm: i A _ , I r " A I _ i
We ........ !..... oA a.l �...i �r!v.... . ► . ,....4Jr..l." r``t .... - �......1.
.... ..]....s....— .... .:.......:3... ....1 .............:......-�...... 9.'3,f...----.............".....".."...............".""...................... w
Latitude ���� �•� Longitude
- Design Current Design Cei rrent Design Current
Swine Ca acity Population. Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
eeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Nninber of Lagoons. : ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holdmgl?onds. / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the S4ite? (If yes, nolify 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 V No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �] No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ................. 3.............. ..........14.............
...... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes tgrNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: — g Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes *0
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
j 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
Yes
No
elevation markings?
❑
lK
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
O No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
[V No
12. Crop type � j�q
--
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
El Yes
� No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
06 No
b) Does the facility need a wettable acre determination?
AYes
O No
c) This facility is pended for a wettable acre determination?
Yes
N
15. Does the receiving crop need improvement?
❑ Yes
[gNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
1Vj No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
0No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
jq No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P'No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Pq No
21 Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
P�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
g No
ivU•VIOI.at16iis,flT deficiendt,S WCrC ho*fea•diti igthls'vls C- Yoi} will-reeeiveRio further -:
.corresnoridence: abouf this visit. .:. ...::::::::::::.:..:....:....... .
3/23/99

Fficility Number: 3 — Date of Inspection
w�
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
M"No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
[-]Yes
"No
roads, building structure, and/or public property)
29,
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
j 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
j7 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
O(No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
KNo
_Comments and/or -,Drawings;_
•i
3/23/99

�, Division of Soil and Water Conservation ❑ Other Agency < Wr,
Division of Water Quality
y �-
Routine 0 Cam taint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection L
Facility Number
Time of Inspection 1 24 hr. (hh:mm)
© Registered 0 Certified [3 Applied for Permit Permitted 113 Not O erational Date Last Operated:
�`S S S v y F county:........��v ���
Farm Name Cu:-i-! 1.-....4 .......ku ! �. fl ,C�llt�.................... Pyf.hr%
...........................................
Owner Name: ............. CU41.5.1.964.rt �r1 r" .. ........ Phone NO: ..... i! ........................................
Facility Contact:.....:.........
....................................................... Title:.....................:.......................................... Phone No:................
Mailing Address: ........................' ..... gX} � lei... Y.�.}.1t,.... [.'.�.C........................ . 4.1........
4 G- I�_..... . .....p�w.
Onsite Representative:...'!?r]`2....�t......i1................................. Integrator:.........A!�llt .. .....................................................
Certified Operator-, ................................................................................. . Operator Certification Number ;......... -...............................
Location of Farm:
.......o .. .......... ...�i :..II........ ..1 d .. �....�?.:1'J.thl Lk ...rA�E13 ......,R.......` .. Z......:.....................................................................................
i
.......................... ............................................................ ... ......... .....I. .. 7
Latitude Longitude
Design - Current Design Current Design Current
7:Swine' . ' Capacity Population Poultry Capacity Population Cattle .; Capacrty._Pbpulation
❑ Wean to Feeder
,Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
U Layer
❑ Non -I
❑ Other
Dain
Non -
Total Design Capacty'
Total.SSLW ,
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes U� No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -wade?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Mai ntenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes R No
❑ Yes No
❑ Yes [ No
❑ Yes ONo
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ Yes rb No
Continued on back

Facility Number'31 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes I No
Structures (Lagoons.11oldingPonds. Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ......._ 5 fit .............. ........... I ................
................................
Freeboard(ft): ..........,r. ........................:g...............................................
10.
Is seepage observed from any of the structures?
❑ Yes
(XNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
K No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
OU No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste
Application
14,
Is there physical evidence of over application?
❑ Yes]
No
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15,
Crop type 1 i................................................. .................. ..................
................
- ..... ......-...
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWlV1P)?
❑ Yes
9,No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[X No
18.
Does the receiving crop need improvement?
Cl Yes
[ No
19.
Is there a lack of available waste application equipment?
❑ Yes
P No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
1 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
%No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fait 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 No
O No.vinlations or deficiencies were noted during this. visit..You.will receive no further
coerespbtidence : tiout this visit
otiment§ (refer to question #) °Explain any X ES ans�yers'and/or hnv recommendatrons,or
Cariy:other comtnents ' ;
Use':drawings of facility to betterrexplam situati�as.'(use additional pagesas necessary} "
x,.
ZZ. 5 nmj -404 S ,- SSTMSL Ij 560 ibs��c ak N� vc�cy, 76fixf w�lnvks
Or%T,,Q �O r -e� ` VA- 1.4_Wo l#-vc, Ir yr 5ST S�ot,(c� �Oc �[,t w � � �L av»--
J
7/25197
'7. �.
Reviewer/Inspector Name ' Y� r w ACZE
Reviewer/Inspector Signature: Date:
s

Facility Number If;str of I�i�i�c;tirtt�
Tintr of 1114Kcc•tion �:� 24 hr. (hh:mm)
p Registered a Certified p Applied for Permit a Permitted 113 I 'ot perationa Date Last Operated:
Farm Name: Ctrrtis.&.Sie.wari.Siraud..Farm................... County: Duplin WIRO
Owner Name: Curtist.Stetvari.............. S.trDud ........................................................ Phone No: 91f129.6-4ftnf..........................................................
Facility Contact: ...................................................... ..Title:............. ...................... Phone No:
A4ailing Address: 96I.E,,..W..axds..Brid ge.Rd................................................................. Kcna Y- lie...NC................................................... Z8.14.9 ..............
Onsite Representative: .................................... ..................................................................... lvitegrator:MiLrphy..F2Lmily..Farm ........................................
Certified Operator:C.lal'.C,.................................. Stroud ............................................... Operator Certification Nuwher:1.7.305.............................
Location of Farm:
Latitude ©• ®® Longitude '1'r • ��®�
esign Curren esrgn current,sign_'Current.
.Swine Capacity Population Poultry,• Capacity Population Cattle'-'• Capacity -Population ,.'
p Wean to ee er
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to ee er
❑ Farrow to Finish
❑ Gilts
p Boars
❑
Layer
❑
Non -Layer
Nurnber of Lagoons./.Holding Ponds ® Subsurface Drains resent 17 agoon rea
p o rqut Waste Management System
In spray Re rea
`- -
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
2. Is any discharge observed from any part of the operation?
p Yes
❑ No
Discharge originated al: p Lagoon ❑ Spray Field p Other
a. If dischat-Le is observed- xv&- the conveyance man-made?
❑ Yes
p No
b. li'discharge is observed. did it reach Surface Rater? (if yes. notify DWQ)
13 Yes
p No
c, lfdkxharge is ohsL'rvcd- xviial is the estimated flow in ,al/min?
d. Does discharge hvhass c la, -loon system? (If yes, notify DWQ)
❑Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
❑ No
4. Were there any adverse impacts to the waters of the State other than from.a,discharge?
❑ Yes
13 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
❑ No
7/25/97

R'
act I ity um er: 3 i 7_34
-771
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La000ns.Hnldiny Pow1k. 11n;ti Vils. etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Stnrcutre 2
Identifier:
Freeboard (ft):
10. Is seepage observed from any of the structures?
Structure ; Structure 4
I I. Is erosion, or any other threats to the i ntegrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-I2 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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
p Yes p No
p Yes p No
Structure 5 Structure 6
15. Crop type.................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (A WMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onk
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
Q .. -violations.or tcien.cies-were -note wring t is vestt:. au vv't .re�ejv� n� urt er . .
at�>res�io�sle....... .... -:.:- .. .: .. .
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
13 Yes 13 No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
Visit was made.to assess if facility is a likely candidate for State groundwater study. Observations of spray field borders were made �
from public roads.
Spray field #1 Iooked a little wet. Spray field #4 and #6 looked dry.
One house (newer) is located across SR1300 from northwest end of spray field # 1. A well was seexi (wooden cover).
Approximately four manufactured homes are also present in this location (may be a -hunting -camp):
One house (newerlbrick) is located across SR1300 from spray field #4. A well was seen,(plastic.cover).
Three houses (two newer/one older) are located across SR1300 between spray fields.#6:& #4.:Each house has a well (two brick
coverslone wood cover). Two manufactured homes were set back behind these houses.
One manufactured home is located across SR1300 from spray.field #6. A well was seen (brick cover). - 7/25/97
Reviewer/InspectorName Aiidrew:G::Hclinin
Reviewer/Inspector Signature: _ r
Date:

* cPARTMENT OF AGRICULTURE
SCS- CPA .lG
.CONSERVATION SERVICE
2 -81
CONSERVATION PLAN MAP
Owner --Operator
-
County_ n�.,11 ^ _ _ State_ N Date o ��
Approximate acres Tr_ _ _. _Approximate scale �� = _960 1 _ _ •,
Cooperating with 1,0,2 1 So;l N/a+r. __ __Conservation District
° Plan identification Photo number
- 3t4 Assisted by USDA Soil Conservation Service
7."
+a -
41
�� r
� �„°antiSk►.� ,.3� � � _ r 3S, "��-��, ti ;mar- 1'" j � � 31�$.� a^�,
e-. `�:. -iL`.' - - l .+k�b$'y�y�"'S'--7 � .��'�`'''�'�f'�•.s'�����r+'l'��1.;ea���•�_-',�4�l��
�7"d :r .::�.�9�:. aet �r _ � ._ tic v c.e -" rs -� ��l ,�- _��'•"` L 4�� .
.� �i_ fr` � 'P =eM -e.F. �y,�c,�. -).- lr . � -•�. L"ct' �.A `�Y"'
� - 1 Ste+ ���^�`•+4 � _ _ 'Y s' _ '�s�. • 6
Al
MY
00
r.s- ..fie ... •s:, „ _', ti-y,::t.,-. p� �t . f.F �.,t �.; z r `:,.
' FF '`•-2. ij: '4�-�� try _.�'"`--_� '�cr. �' � f � � �'�� 'r• '.�. -3-
j;'I ?fi....w q , \`-- T s j • 'r� '-:i!• ram." �'.a , ^ ''a.' -{ter
1st
k.
` •'�,� � ��y�S�y�as:m, ,�-%�y�+pp� � Y � 'a��,.' •'.�ri:�'-�' �'rr .yr t, w� +.a-: ��- ' 1
Mw
Ll
a _ -� - u r.+1'�•� - - is ' 3: K �- '+ �3 � r -s �- �4rs C* "�iki `�'�li�t•:.r��� 4 .
fia�i }�.Lrti r-,�t 'Yt •t) *'W .j.e _ .y •�;_ i � Yc,�:�f1s'� _ ��:.5; �� �.� y /
+ -�'_ri ��: ��� �f �-.��'Sa,C.t �. ,{ .r 4r I .��, •!!: �.�i�!,'w'kV<�»��fs.�C� �.-.
4 -ts NZ
r �•�y�'
. ram. v � �' ; `•�+!��",��� , \ �� �`'

10 Routine 0 Comelaint 0 Follow-up of DW2 inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 17
E: Facility Number 3
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours -
0 Registered [I Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review 2-
Farm Status: gCertified 0 Permitted or Inspection (includes travel and processing)
0 Not Operational Date Last Operated:
Farm Name: . ...... county:
Land Owner Name: ... . .... Phone No:-L3A..Q zg(. -OPU.4 . .....
Facility Conctact: ... . . ..... . ...... . . ..... . ...... . ....... ... Title: . . ...... . . .... . .... . . ..... -, Phone No:....__..... . . .....
Mailing Address: .....
Onsite Representative:... . ..... . I - ----- ...... .
Certified Operator: .... cla .... x1- ............. ..... Operator Certification Number: -113P.S .... . .....
Location of Farm:
LYN. EL k.1I ±:L--. --j . ........ ...... ......
Latitude 0 6 " Longitude
Type of Operation and Design Capacity
W
P
gn
V.- "es 7 19
M
licipN3.5
5
opu I
—Iry I I Q Wean to Feeder La FE❑ Dai
Feeder to Finish ❑
Non -Layer ID Non Da
91
M ;I
0 Farrow to Wean
'2
Farrow to Feeder 'Y
Farrow to Finish U-154 'zo
WTIkil I UUV IDU ZSSL"
❑ Other
Number of Lagoons 1 Holding Panels Subsurface Drains Present
TU:
Lagoon Are Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon 0 Spray field 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water`? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
0 Yes IN No
[I Yes 29 No
[I Yes ONO
0 Yes &No
D Yes
IR No
0 Yes
91 No
❑ Yes
Iff No
Yes
[] No
Continued
on back

Facility Number: , �..... —..„_
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes iZ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes KNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 9 No
Structures (Lagoons and/or Holding Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes J,No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
y__..... �.... _ .... _ ... _
10. Is seepage observed from any of the structures? ❑ Yes E'No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 19 No
12. Do any of the structures need maintenance/improvement? [:]Yes EKNo
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type V......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
IS. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
r Ce0fied Facilities QnLy
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24, Does record keeping need improvement?
❑ Yes KNo
❑ Yes JELNo
❑ Yes 19 No
❑ Yes 1K No
❑ Yes
IR No
❑ Yes
IR No
[:]Yes
J4 No
❑ Yes
Pq No
❑ Yes B[ No
❑ Yes ® No
,j Yes [:]No
Comments (refer to queshon #f; Explam`aiiy YES answers`:andlor any recgmmendattons oar any4other comments N
Use:drawings of facility to better explain srtuahons'(use adclihonal pages as necessary} .
,:.
5. P y i t d V a S w_o_ L k la P.r.-.r. x v -n u y,� e- �k � of-ra+1 f im p► 4,V Q_" �`
v'vti.o�� I.+ttt? 4te.o..vLoyd� tea.
2-94. t C u r- -vl. E` s o i l 0-+�.-o� w N .t e S o....... i,e� t-a �c...� , ArA S o) v•* It t X v Ye-
4
{-6 W V- i f'r-*- rr k v +^ + b 2-r p ,� b U r i v r g rL { i t t� v e co v�1 .
1i e a tA-%L L u (f a r.{ o +r �v �^-d t d i c k eVI
� l9
8
Reviewer/Inspector Name 'f A v_ '; ... k •
Reviewer/Inspector Signature: Date: .�
cc: Division of Water Ouality. Water Duality Section. Facility Assessment Unit 4/30/97

CJ
Site Requires Immediate Attention: 100
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: - _ �_ ^ o , 1995
Time: 13 1
Farm Name/Owner: 5 C—ir "'j Q S T
Mailing Address: l k' U i u� �: �� vt �. s y'.� Z u 3 q
County• D .0 o
jr�1 C/ r (9 1 o) 2.16 - 0 i 5 i a re f
Integrator-. Phone:
On Site Representative: Phone:
Physical Address/Location: N CS M- ('�O O 6.
Type of Operation: Swine. ✓ Poultry Cattle
Design Capacity: r--)- 44 i� Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 S` O 1'' D 3" Longitude:_1 I ° 3 7" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon hMYrNo
ficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches 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 Y, or No Is the cover crop adequate? es r No
Crop(s) being utilized:'
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?�r No
100 Feet from Wells?(Mor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(E)
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- a state by man-made ditch, flushing, system, or other
similar man -trade 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 o No
Additional Comments: \') 1 Ke 5 C'eq— is 1 v��
) ( r IG Ye_ c.
�� --e 3�_
Inspector Name
cc. Facility Assessment Unit
Signature
Use Attachments if Needed.

Site Requires Immediate Attention:
r . Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT 2 _
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD l`
DATE:
Farm Name/Owner: 5S� Foron Pair
Mailing Address:
County:
Integrator. Ur IDh !,�_ Phone:
On Site Representative: Phone:
Physical Address/Location: '10 3 f�oyn K—vdie, leFf- rn ` 13c m i•. ova IR
Type of Operation: Swine J� Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: j'L ' 4Z, 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) Ye or No Actual Freeboard, 5 Ft. (P Inches
Was any seepage observed from the lagoon(s)? Yes or N� Was any erosion observed? Yes o No
• Is adequate land available for spray? Yes or No Is the cover crop adequate? es r No
Crop(s) being utilized: 6eemU�2
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 or 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.
k.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No Z_
Additional Comments: Ny '0R0 d� s442 . Pa
L. Le.W+S
Inspector Name
APL� - -
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: 2. 33
Farm Name/Owner: _ p0 r1a 2
Mailing Address:
County: _ Dof,
Integrator. KL
Phone:
On Site Representative: Phone:
Physical Address/Location: _9U'; lrCv,-, �, 1-e . W-4- O/%_ _F_X11
P4
Type of Operation: Swine C/ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 35 O ' Z4' 11 Longitude: 1� S2 ' 1)0_7" 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) De or No Actual Freeboard: Ft. Inches
Was any seepage observed from the iagoon(s)? Yes o No Was any erosion observed? Yes or No
• Is adequate land available for spray? Yes or Noz Is the cover crop adequate? es
Crop(s) being utilized: �� 2 _
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 or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o
Is anitnal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes olo 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 2
Additional Comments: 06 ' oil e On -5+e .
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Inspector Name
_4J-1
Signature
cc: Facility Assessment Unit Use Attachments if Needed.