310096_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua
II

r1
�.- °� '��. u• "eke "sa -±a :
FacilitNumb`er. 4-� D�vis�on of;Soil nilWaterCons_ery hon a
k ,�� Other�Age y� ^.�.,.„
Type of Visit: (DrComp ' nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: vL1� Departure Time: 3 9 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 94 1 Cu, Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current` b D ig C r~`
- �:
Design Cnr�" e'n
Sivme
Capacety `Pop Wet�Pouit'. Capacity �'P�op.=Caitle
Capacity. Pop.
�
DairyCow
=Non-Laye�r
DairyCalf
.� �, w "�"�..
Da" Heifer
L �' Design Current
�w
`P,o
D Cow
D .1'oult ."" Cai _.
Non -Da'
t Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
' TurkeyPoults
Other
'' Other
Wean to Finish
W `to Feeder
eeder to Finish
3 �
� �
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑
]rNo'
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

I
Facili Number: - Date of Inspection: '11f"117
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes [2rl�_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: f ? 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4il 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 ONo ❑ 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 Yo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ala ❑ 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 C2f Co❑ 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 CfNo ❑ 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
�o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
gNo❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
/No
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
gNo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
I_ H<o ❑ 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
[�=.-❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[]Yes
[]No ❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: jDate of inspection:
24. Did thd;facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No ❑ NA ❑ NE
25. lathe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E2 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [7No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes g?--NA ❑NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Commnts�(refer touestion'f#}:�EzplainanyYEBtanswersand7,orany�ada�tronal recommendat onsor any�ott►e comments.
U"se draw►ngs�ot'Ifacility to bettervezplaws�tisatinps;(use: add�hooal;pagesas, necessary)..., �,. ��,�. �. �,. • '��.,�. 4.. ,,�.F ,
` W7
Reviewer/Inspector Name: 'I a e i% Phone: 9 NG 7)1
Reviewer/Inspector Signature: _ _ , Date: 2' �o �T
Page 3 of 3 2/4/2015

Division of Water Resources
Facility Number L_ 2_LJ - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: o ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: D .S County: f.�'-1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Swine
Integrator:
Certification [Number: I7 / Y6
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er 1 4:��
Wean to Finish
can to Feeder
Feeder to Finishgi
3Zj
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Poults
Design Current
Dischar es 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 P'IVo -❑ NA ❑ NE
l
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ No
❑ Yes �o
❑ Yes WNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment ���
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .E� ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 PoEINA
NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 0 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 EfNo
❑ 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
❑ Yes Ej�_No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �'1 f�O
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes lo_
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E]"go
❑ 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 PKo'
❑ 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 f No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 - 21412015 Continued

Facili Number: 3 - Date of Inspection: 31
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes cD. l ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �Q-N—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?
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? ❑ Yes El —No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ff- o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments(refer; t0:questi6n4):; Explain°any-YES answers and/or any additional recommendations or any -other comments.
Use -drawings' of facility ti) biter'explaia°situations (use additional pages as Inecessary).
❑ Yes No ❑ NA [3 NE
[:]Yes ❑ No NE
❑ Yes y - ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ❑ No ❑ NA',E]'�E
1 q r• G�
t?`V t C .� --�- ' Phone: -7 � r
Date:
24,20 5

�trc asa • aaaa. V t.asaaaraaaua.c ivarcc aal/u `/ vEac■ aaaou acc �acn V �aa ucauac u�aauaawu LJ aca.uuaa.aa c»�aa aaucc
Reason for Visit: outine p Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 0-5 Departure Time: / y County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: N A A C9r] e/
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current ; Design Current . wb Designer Current
+. Tn- R M�$'ri.a 1 >w -"1+Ea4+na'k s EN>lyv.. „yd
Swine t CapacEtyrPopy.�Wet Poultry. Capac'iy l'o Cattle , "C pac tyPopAd
Turkeys
Cher. TurkeyPoults
• -
w
-
Other
Other
Wean to Finish
�r.
La er
Dairy Cow
Wean to Feeder
Feeder to Finish
2Q
R(�
� Non -La er
� �,.`` . , -• � Design :Current
�*Dr Roul '� Ca _acr4TPa
� tyV
Da' Calf
Dairy Heifer
Farrow to Wean
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
a ers
Beef Stocker
Gilts
qNon-La
ers
Beef Feeder
Boars
ullets
Beef Brood Cow
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ g-o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q"No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214/1014 Continued

Facili / Number: - Date of Inspection: 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 [a If
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [:j'No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes dNo [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EJ'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 I ZJ No ❑ NA 0 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 101bs. ❑ 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 �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [/] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I/ I No
r
❑ NA
❑ NE
Required Records & Documents 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ErNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - % Date of Ins ection: 7 r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ 'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes u No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [ f No ❑ NA Ug.*E
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes EJ-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?
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 CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [ 0"N' o ❑ NA ❑ NE
❑ Yes E?J'No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
[:]Yes ffNo
❑ Yes E! f No
❑ Yes [/rNo
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Signature: Date: /
Page 3 of 3 214120I4

Division of Water Quality
Facility Number ©- ® 0 Division of Soil and Water Conservation V
0 Other Agency
type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
leason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: caas ��` � Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Region:
Integrator:. h �j.
Certification Number: lr d m 4j q
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
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Nan -La er
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
'Design Current
Cattle Capacity Pop .
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 9 No
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
[—]Yes O-No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): sa
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
VNo
❑ 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
KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
W-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
VrNo
❑ NA
❑ NE
maintenance or improvement?
Waste AP lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
7TNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
VfNo
❑ 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
P_'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ONo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ 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 PNo
❑ 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 j�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes TFrNo
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

acili Number: - q I Date of Inspection: — —)
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 7No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes No
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes No
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 CAW -MP?
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?
[] NA E] NE
NA NE
NA E] NE
NA NE
❑ Yes P No [] NA NE
Yes t6 No ❑ NA NE
Yes VI No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
[] Yes No
El Yes No
F] Yes No
NA NE
NA NE
[] NA [] NE
Comments (refer to question #):Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:aZ�,1^,�Si,�K}
Date: &A
sf ,21412011

Division of Water Quality
Facility Number - ME]O Division of Soil and Water Conservation
Q Other Agency
Type of Visit:C.o/mpliance Inspection O Operation Review p Structure Evaluation Q Technical Assistance
cp Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time:
'
Departure Time: r
County:_
Farm Name:
Q� ,
_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: O&zn,,,, i'
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:
Title: Phone:
Latitude:
Region: VIF-4 0
Integrator:
Certification Number: rl
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[Layer I I __j
Non -La er
Design Current
Dry Poultry C'anacity Pan_
Layers
Non -Layers
Pullets
Turkeys
Turkey Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes 2[ No
❑ Yes �3 No
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
eNo ❑ NA ❑ NE
,�TNo ❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J�j 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 ja 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 .2 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2TNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;a No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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.
❑ Yes
Zr No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
Pa
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes PTNo ❑ NA ❑ NE
❑ Yes g] No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo
❑ 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 .5 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

.r- c
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes. No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZrNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes n/ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Vj No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
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 4No ❑ NA ❑ NE
[:]Yes P No ❑ NA ❑ NE
❑ Yes ;KNo ❑ NA ❑ NE
[:]Yes .21 No ❑ NA ❑ NE
❑ Yes 2fNo
❑ Yes Pj No
❑ Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
0
Reviewer/Inspector Signature: K�Date: 3
Page 3 of 3 2/4/2on

Division of Water Quality
Facility Number 3 1 - &7 O Division of Soil and Water Conservation
Other Agency
�
Type of Visit: ZgCompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
[teason for Visit: '�h Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:J Arrival Time: ® Departure Time: County: L! Region:
Farm Name: 't>p I L- Ga(Z-M --, ) Owner Email:
Owner Name: �QIL r��1i�� I7�1G Phone: q!q' (DS9—/666 E)er ?,QiS
Mailing Address:) "I 2L/ 5uME(ZL/itl S e�h5�'iri+q�S W�t"JGcN T VZs VE� ��3 �DS
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �t%/v L&
Certified Operator: LO Lb N .
Integrator: c
Certification Number: a I
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
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:
Design Current' `
Cattle Capacity 1, Pop -
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ YesgNo
No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214120I1 Continued

Facility Number: - LI/ (p jDate of Ins cction:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ""7� 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: m
Spillway?:
Designed Freeboard (in): ,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes t 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 VNo ❑ 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 pqNo ❑ NA ❑ NE
,
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �2 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? Iq
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes A No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes k 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 Q 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
'JANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yeso
tN
❑ 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
77 No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists QDesign Q Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X
No ❑ NA ❑ NE
M Waste Application Q Weekly Freeboard Q Waste Analysis [•] Soil Analysis ❑ Waste Transfers Q Weather Code
❑ Rainfall ❑ Stocking ❑ Shop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections Q 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 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: DE/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �kNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No V NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 4No
❑ Yes 0No
❑ Yes VNo
[—]Yes ANO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any
other comments
Use drawings of facility to better explain situations (use additional pages -as necessary).
"_A u (swj l o'+/ Du L 90 ! o
Reviewer/Inspector Name: N'q'V0A- Phone: $0 —�1_110Z4394
Reviewer/Inspector Signature: . Date: )_j� a
Page 3 of 3 21412011

Division of Water Quality
Facility Number -l�p 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit A Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Arrival Time: Departure Time: County: u N Region:
Farm Name: /-_'G5geeV s�"wE Owner Email:
Owner Name: (as//GiV Swi.ve �>VC- Phone:
Mailing Address:
—ICY-"I
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: N 1
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 No:
Integrator: 1
Ope� rator Certification Number:
Back-up Certification Number:
Latitude: = n ❑ I = « Longitude: = c ❑ 1 = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: 71
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
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
4"
❑ NA
[INE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: — (p
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes X 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: C A60C>Af
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
A
ElNA
(INE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes f No
[INA
El NE
through a waste management or closure plan?
iI �
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes kNo ❑ 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) a
13. Soil type(s) AL..,
e:>
14. Do the receiving crops differ from those designated in the CAWMP? [--]Yes ti'No
o El NA El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yeso ❑ NA [I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ttol_
❑ NA [INE
18. Is there a lack of properly operating waste application equipment? ❑ Yes❑ NA ❑ NE
Comments.°(refer towquestion`P): Explain any YES answers and/or any recommendations or°any„other omEnent
Use drawings of facility to better explain situations. (use additional pages as necessary):'
Reviewer/Inspector Name {� N { /1V (� S k ... Phone: C 1 t~]
.l�:.
Reviewer/Inspector Signature: GUvYLlj Date: 3 %3 v/I/
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
kNo
ElNA
❑ NE
0 �Elthe appropriate box. p Checklists Design 0 Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ YesXNo
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Vaste Transfers ❑ AAual Certification
❑ Rainfall ❑ Stocking ❑ C/op Yield Q 120 Minute Inspections 0 Monthly and V
Rain Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1ANo
❑ 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
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
*o
❑ 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
El NE
and report the mortality rates that were higher than normal?
Ili ���\
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
0
ElNA
❑ 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
o
to
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings
�DLA_ C-_r
5�v
�r�5f�1 1.a
T
Page 3 of 3 12128104

Division of Water Qaahty, `
�+
Lac_flity_�umber, 3 9� O Division of Soil and Water Conservation 4
Other Agency n ..
Type of Visit Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )�Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: a Arrival Time: Departure Time: County: 1 Region:
Farm Name: �c�srl_ _I �� _ Owner Email:
OwnerName- C'�5j*_N &A_-) I 'V e hvc Phone: [phone]o06 CXT 3 3 d�4
Mailing Address: ``# r LJ��PkZ— C10
Physical Address:
Facility Contact: Title:
Onsite Representative: vy
Certified Operator: N e
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number: �� }
Back-up Certification Number:
Latitude: [� c = 6 = it Longitude: 0 ° = t = «
Design CurrentDesrgn Current `` `� ` "� Desigi Current,
..
Swine... Capacity Population Wet Poultry :Capacity Population y� Cattle 4Capacity1Popula�ttao
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
N
L*Xd
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry PPoultry '
Pullets
❑ Tu
:.Other ❑ Tu
❑ Other: ❑ Otl
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
NonNon�
Beef Stocker
Beef Feeder
Beef Brood [
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 ANo ❑ NA ❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes tNo
o ElNA [INE
❑ Yes ❑ NA ❑ NE
12128104 Continued

r
Facility Number:
Date of Inspection 19 G Id
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S
Structure 3 Structure 4
❑ Yes X'No
❑ Yes ❑ No
Structure 5
❑NA El NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ 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 [INE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 ElNA ElNE
maintenance or improvement? '' \\
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below
❑ Yes No
❑ Yes �No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
[]PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)(Z
13. Soil type(s) f `I cif Y s �-o A
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 ,2_ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes JK No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [VNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes JErNo ❑ NA ❑ NE
Ya. ae'a
Comments (refer to question'#) Explain ahv YES'ansKers and/or any r commen'datrons or anylot her comments. , ":
-Use drawings.of facility to better explain situations: {use additibnal pages�as necessary):^
Reviewer/Inspector Name j �; m '*� C}/d -V1(0
Phone:
Reviewer/Inspector Signature: Date:94,101,10
12128104 Continued

Facility Number: I — Date of Inspection OP 6726
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No [INA ❑ NE
the appropriate box.
E] WUP [] Checklists 0 Design 0 Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes '{ No
❑ NA
❑ NE
ual Certification
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ )Vaste Transfers CltWeathei­Code
• Rainfall Stocking ro Yield 120 Minute Inspections [� Month/ and 1"
❑ ❑ g ❑� p ❑ P Y
Rain Inspections
p
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes )� No
❑ NA
❑ NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Cl Yes No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes �No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes )a No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes -9fNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes VNo
❑ 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 PqNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes ANo
❑ NA
❑ NE
Additional Comments and .or Drawings:
A a
!1'ao log.
0Ci
12128104

Type of Visit (Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit kRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: w lV Region:
Farm Name: �10���N1�V 1' Owner Email:
Owner Name: G01 5W L/\l F )1V C ._ Phone: 1O - �OSg-iaoc� £X r 33�
Mailing Address: LOLI E AGKMCa'F_ l-d LA_'�AQSALA, � � . /[9 S C?',^
Physical Address:
Facility Contact: Title:
Onsite Representative: �lMNN coor.=�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
f 1 Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feede
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ L ❑ « Longitude: ❑ ° = 6 ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
d
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non-Dai
❑
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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�J� No
❑ NA
El NE
El Yes
;9 No
❑ NA
❑ NE
Page 1 of 3 12178104 Continued

facilitiumber:3 I _ (p Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes XNo ❑ 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: LAGOaA
Spillway?: Q
Designed Freeboard (in): 19.5
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4 No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 ElNA ElNE
maintenance or improvement? 9
Waste Analication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
H. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) Ge(L ( Q"")
13. Soil type(s) A (J'> FQ A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Xj No
❑ 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
rXNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
iJ No
❑ NA
❑ NE
01C'Oq CADS NOTC)CATt6e1 - G�� V11kVLS <31C )4c_7-iuC
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — (p Date of Inspection C1 Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
KNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA ❑ NE
the appropiate box. 0 WUP 0 Checklists 0 Design ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0,'No
❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ �aste Transfers
❑ )Anual Certification
0 Rainfall Q Stocking ❑ Crop Yield 0 120 Minute Inspections [:]Monthly and 1"
Rain Inspections C]
Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10 No
❑ 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
1,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IP No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
t No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
K] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10 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
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
� 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
�] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

rr
i,,
Facility Number
0 Division of Water Quality
0 Division of Soil and Water Conservation /
O Other Agency l/
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �d� Departure Time: �� County:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: )'IgA/yNC1 C )� � EAN C2We_F- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = ' = « Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Fa er
Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
tl3 C)
I Y9 OD
❑ Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — �'J'�p Date of Inspection f a3 08
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: LAC 001V
Spillway?:
Designed Freeboard (in): ) 9 -05
Observed Freeboard (in): 3` 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
,�,{
IG1 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
9No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 14 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 Pn No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P1 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [XNo ❑ 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 CAW -MP?
❑ Yes
[N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
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):
Reviewer/Inspector Name I AMjqpjChqC jgj1VF SotIM FA (CNr=cL Phone: 110 -_+c/(D"-4 �a
Reviewer/Inspector Signature: Date: p-3 In $,
Pane 2 of 1 12128104 Continued

'1
Facility Number: Date of Inspection �3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage &Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 1�j, No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other ,,..++��
21. Does record keeping need improvement? If yes, check the appropriate box below. El2
Yes 9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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:
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
R1 No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
[I NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
� No
❑ NA
El NE
❑ Yes
R) No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes E� No. ❑ NA ❑ NE
❑ Yes J4 No ❑ NA ❑ WE
Page 3 of 3 12128104

Facility Number
jO Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: J� /G�l/jJ Arrival Time: �. /0
/ ' d Departure Time: � Q County: � Lz Region:
Farm Name: _ TO.5 jtiv jj__7 JF_ Owner Email:
Owner Name: �y 54ss;" _ :5--w /�-�-.tiJ/:^ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: j 41 oaPF
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
Phone No:
Integrator: Aee� i<'
Operator Certification Number:
Back-up Certification Number:
Latitude: o [—] ' Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
' ❑ La er
! 1; 0 Non -Layer - - - - -- -
Other
❑ Other — - - - - - -
Dry Poultry
Pullets
LI 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ DaijX Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©I
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
PNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: R= Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O-No El NA El NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ No ❑ NA ❑ NE
St cture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: JV0
Designed Freeboard (in): 22
Observed Freeboard (in): V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes .0'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 FfNo ❑ NA ❑ NE
8. Do any of the stuctures 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 No [INA ElNE
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 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 ElApplication Outside of Area
12. Crop hype(s) ep`�-�1-11Z.1" -7 -0U��SE /J
13. Soil type(s) 0
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
X,(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
J No
11
❑ NA
❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other
Use drawings of facility to better explain situations. (use additional pages as necessary):
IReviewer/inspector Name r� �lAA { Phone: (61/D) 7 ;132 '7- 1
Reviewer/Inspector Signature Date: 3 2Slp -.
Page 2 of 3 12128104 Continued

i
Facility Number: Date of Inspectiion 3 a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ff 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 ONo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes /�/0No
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ;dNoNA
Aelep_
ElNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes ` No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
//..�(
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 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 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

/0 Division of Water Quality
JFadility Number 0 Division of Soil and Water Conservation
- - - - - 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit fi6 Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f Arrival Time: 5 /1+ Departure Time: County:
Farm Name: F Owner Email:
Owner Name: ? PS�i�n/ �✓C�• Phone: _
Mailing Address:
Physical Address:
Region•
Facility Contact: Title: Phone No:
Onsite Representative: 9N ��� 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
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0'= Longitude: [—] 0 0' 0 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
1� 10 Non -Layer I t
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: Il_._.J��
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 10 No ❑ NA ❑ NE
El Yes
El No
El NA
[I NE
❑ Yes
❑ No
❑ NA
Cl NE
❑ Yes
❑ No
❑ NA
❑ NI✓
❑ Yes �No ❑ NA El NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

f.
t
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Xr
1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: .(%D
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes /No El NA El NE
❑ Yes
//❑No El NA El NE
Structure 5 Structure 6
❑ Yes A No ❑ NA ❑ NE
❑ Yes )�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Zo No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 [I NE
maintenance or improvement?
Waste ADD]ication
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 /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 W/iind D 'ft ❑ Applicatio Outside of Area
12. Crop type(s) %i¢-Z
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
VNo
❑ 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
keccv'J-jr
'4?;Fq'
/vo Ael'a Z
Reviewer/inspector Name %� T r Phone: 9149
Reviewer/Inspector Signature: Date: 2
Pap,& 2 of.? 72 8104 Cantinued

1
Facility Number: — Date of Inspection Z d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? OYes ❑ 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
/No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9fNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
XNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
'0
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
/ No
El NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
////,_,(
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El�J Yes
No
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 12128104
Page 3 of 12128104

4,
[Fac'jiity_--Nu'rilber��
�Division of 'Water, Quality: :
0 Division of $oil.and Water. Conservation
0 Other Agency'
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: O5� Arrival Time: �i Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator: _ 5
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = g a Longitude: = c=,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Weeder to Finish
ZV
000
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - - — - - --
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 121
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?
Q&
❑ Yes ?1No ❑ NA ❑ NE
El Yes
❑No
El NA
❑NE
El Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
?I No
❑ NA
❑ NE
❑ Yes
"No
❑ NA
❑ NE
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes tvNo ❑ 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?: O
Designed Freeboard (in): f �.i!�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any oft he structures need maintenance or improvement? ❑ Yes
�f No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
�VNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
;dNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
0No
❑ 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 Outside of Area
12. Crop type(s)
LApplication
%
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
91No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PNo
❑ 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
�&
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refeto questions#)Exp[am' €anyyYE5 snswersandlor any recommendations or any other comments.
a ,• ;
Use drawmgs.of fac�tAwfietfer.,ei tam�s�tuattons `{nse�adi}Ehonal"pages as necessary):
.ti'
la jf dr�,,►�F_,��� pti 71� J- Go.
171.4 rJ9r951J Fj0.
Reviewer/Inspector Name =�� - 3 . :�-t� Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )zNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes No ❑ NA El NE
the appropirate box. ElWUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X 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
3 L 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:
❑ Yes PYNo ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
/inNo
El NA
❑NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes �( No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
to No
❑ NA
❑ NE
❑ Yes
/No
❑ NA
❑ NE
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes ZfNo ❑ NA ❑ NE
12128104

. ,�,. s! e �.:;� .e;ch.<..� ,-� _,.:lJ 1'iiViStiAl�.Af<WQfPT•,�7AtifV�. _ _®,.� '�.,.,Z�—
ggiF
,.-
-
Type of Visit oGompliance 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: Time:
'�pNat O erational O Below Threshold
Permitted Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
e
Farm Name: - ---- ...-------- ---------- County:
Owner Name: ... .... ..._._................................ Phone No:.......
Mailing Address:
Facility Contact: ......_..W_.W.........._ _......_ _ .._._ Title:.. _.. _ ...._ ...... _ Phone No:
Onsite Representative:--__..xl+'�. Y�,o, �E� .... Integrator: ..... ......................... .
Certified Operator: --.. _ .�__.........._ ............................................. Operator Certification Number:.......
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • ' "
Disc-harg-es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 7N9
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... ............ ... �__ .. w. - ...... __.... _ .. w .. w .__.... _ ._.._..._ __ ...
Freeboard (inches):
12112103 Continued

Facility Number: -- 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes /Xo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes /No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ElYeso
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes /Noj
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type �(a- W cp CG e)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes o
Air Quality representative immediately.
comments (refer touest<an.#) Episus ari YE5 answers and/or any iecomx�neodst;ans or_any other cnmeuts.: -
Use drawrngs of fadity to better explain s�at3n s `( a d ott nai pages as necessary) 0 Field Copy 0 Final Notes�
r
AL
-
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
12112103 1 / V Continued

Facility Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ 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 I2 o
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes O
27. Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes �T
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Eal es ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W9"
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes Nq5
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes
34. Did the facilityfail to calibrate waste application equipment? ClYes 20,
PP �I P
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 7 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine O Complaini O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 18 Time:
Facility Number
Not O erational 0 Below Threshold
Permitted d ertifiedt 0 Conditionally Certified [3Registered Date Last OperpNd or Above Threshold:
Farm Name: e5� J �_Sw ct4 ra Coanty: L Aj i' I
Owner Name: Phone No:
Mailing Address:
Facility, Contact: Title:
Onsite Representative: fl
R'Oop ER
Certified Operator:
Location of Farm:
Phone No:
Integrator: 0, k2 R wu 5
Operator Certification Number:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude ' ° u
Design Current
a Inc 4-apacury ro ntanon
❑ Wean to Feeder
eeder to Finish `LQ11
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
Boars
Number of Lagoons
Holding Ponds i Sotid'Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer i ElDairy
❑ Non -Layer I I I ❑ Non-Dai
❑ Other
Total Design Capacity
Total SSLW L
Subsurface Drains Present IFEI Lagoon Area
No Liiuuid Waste
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
Field Area 1'
❑ Yes )d No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
ElYes
/P1
x No
❑ Yes
No
Structure 6
Continued

1 . .
Facility Number: Date of Inspection �� D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
INO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
VN0
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
O
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
H. Is there evidence of over applicatio ❑ Excessive Ponding ❑ PAN ❑ ydraulic Over oad
❑ Yes
VNo
12. Crop type -Z V E
13. Do the receiving crops differ with t se designated in the Certified Animal Waste Ma"ilagement Plan (C WMP)?
❑ Yes
No
Pf
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
JLJ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
/ o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑Yes
No
�XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWNIP?
El Yes
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coo a h refer Ea quests Eplai,y YrEStanswersand/or any �ecommenaansorany,otherommeats "
I�
WA—
Use ngsiof facility to better xO1atn sttuations- (use addttionalipages,as necessary)
. v�r a�. ', A Field Copy ❑ Final Notes
4,F F;; .. .1 .L'a: -
I��
ocr, 3 o Atio Sa QZ Fo R rFe , 70 M we f#_
5-r_r_�o k `ro `rN c A m VUN Ys IAN a APP�- c P,.,- 0
W'v-o 5.
Reviewer/Inspector Name r TF g
Reviewer/Inspector Signature- Date: 2
05103101 Continued

Facility Number: 3 — Date of Inspection p 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 AYor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes XNO'
❑ Yes x No
❑ Yes �No
❑ Yes 7N0
❑ Yes V-No
❑ Yes [�io
❑ Yes /❑ No
AdditionaVUornments and/or rawings: F ,
C) ER►
i
5100

e
r
-C
�aisPT ooWoatCr aer:.stQ aiservaxon
_ e v
a §
c a-- a Other }�genCll. , s s 1 F
F
pe of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
eason for Visit 9f Routine O Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number 1 Date of Visit: Time:
Q Not —Operational Q Below Threshold
Permitted © Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName:,91_....SW.�'�'-................................................................. County: .....1"............................... .......................
OwnerName:........................................................................ Phone No:...............................•.....•.................................................
Facility Contact:
Mailing Address:. ..............................................
Onsite Representative:.,0. ...........................
Certified Operator:
Location of Farm:
Title: ................................................................ Phone No:
..................................................................................... ..........................
Integrator:.�� �w'.........................
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��
Design Current 'Design. Currenit' ' Desrgn. _ Current
-Swine Capacity Population PoultryCa Capacity PoulatonCattle
CalDicity= Po ration.
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish 3a-0 ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish TotaiDesign Capacity
❑ Gilts .
❑Boars Total,; SSL W
Number.of'Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid'Traps ❑ No Liquid Waste Management System"
Disehar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
`'
❑ Yes �J No
Discharge originated at: ❑ Lagoon [I Spray Field ❑ Other
"`
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, -notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
;No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
WN0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ................... ....................................................................................................................................................................................................
Freeboard (inches):
5/00
Continued
on back

i
Facility Number: — Date of Inspection Printed on.• 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 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 KNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes XNo
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 ;ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes KNo
12. Crop type �l �i.c.2s�$+-' \
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
RNo
b) Does the facility need a wettable acre determination?
❑ Yes
j No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
PTNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
VNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑ Yes
b(No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[2�No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes�1!! No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
O�Vo
(ie/ discharge, freeboard problems, over application)
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
0No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NINO
:: ivH-yiolaiior;is'ot deficiencies were noted• d . ih. thlsMsit; • Y:o>i� Will •reeeiye ii6 further
corres�o deice. ab' , f this visit. • • � • � • • •
Conicgents ((refer to question #}: Explain any YES:answers andlor any recommendations or:aay other comments_
Use.4rawings of faeiliity to better explain situati©ns. (use_additional pagesmas nec - essary..
F , k 4, Sewc� sz,w 3 i�S�o
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: _ ~�j —a [ 5/00

Facility Number: Date of Inspection Printed on:
10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes 1JVo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
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 e 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 No
lAdditional-Comments.andfor-Drawings:
R
5100

1: 0 Division of Soiland Water'Conservation Qperation Review
'" „t ©Division of Soii'and,Water Conservation 'Compliance inspection
3 vision of Water Quality' Compliance inspechbn r
..Other Agency Dperation Review,
Routine 0 Com Taint Q Follow-up of D= inspection tQ Follow -tip of DSWC review Q Other
Facility dumber Date of Inspection b
Time of Inspection . / 24 hr. (hh:mm)
Permitted © CertifieLCondilionally Cerrtiff ie��d [3 Registered [3 Not O erational Date Last O erated:
FarmName: rfi{iv.. County:.................................•----g.-.........-..--..-.......................
Owner Name: ............. ............................ . Phone No: -.....-......-.......
Facility Contact:..- . - .--.......0 .- .. Title:....,%..... Phone No:.. .................................................
� .... .....-.... -...............
Mailing Address: ............ ........................ ..............
.... .. .............ax-4w-�
...................... ...Onsite Representativ... ............. Integrator:.......................
Certified Operator: ................................................... ............................................................. Operator Certification Number:...............-..........................
Location of Farm:
Latitude 0 4 •6 Longitude • 6 &�
Design Current. Design Current--- Design Current
Swine _. Ca acity Po ulation Poultry Capacity -Population Cattle Capacity Papula Bon-
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer = ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
. ❑Farrow to Finish _ Y Total Design- Capacity
❑ Gilts,
❑Boars Total`SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes
o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes R(No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes to
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 _jjrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ANo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure fi
Identifier:
Freeboard (inches): ........
...... .... ..... ...........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.) AN
3/23/99 Continued on back

Facility Number: 31 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes [�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes o
XN
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes D�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes XN 0
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes FZJeNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes $No
b) Does the facility need a wettable acre determination?
❑ Yes jNo
c) This facility is pended for a wettable acre determination?
❑ Yes�'5t-D10
15. Does the receiving crop need improvement?
❑ Yes 090
l6. Is there a lack of adequate waste application equipment?
❑ Yes D�No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes kNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes $—No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes IETNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes `y -h10
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes )9�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ;No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ZNO
24. Does facility require a follow-up visit by same agency? ❑ Yes ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes VNo
violations :or• d fde.ncies •were hated• during this:visit: • You wll •receive iio furthgr ;
.: cor'respotide'ce: ahonit this visit:
Comments-{refer>to.qu estion #):-Eiplain any YES answers and/or any reconnmendations or any other.comments ;
.T
Use drawin of faciht to hetterex laEn;srtnah©ns use add,tional`pa es _as necessary) -
y.. P ( _ gX4,A/ 4� C,— Alel)oe
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
3/23/99

Facility "umber: -,A
Odor Issues Date of Inspection d
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes VNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [io
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes YNO
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 ,E![N0
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 40
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 'r No

0 Division of Soil andWater'Conservahon :,Operation Re' iew
f
0 Division of Soil and -Water Conse&6tion Compliance'Iiitspection
,sDivision of Water Quahty Compliance Inspecti©n Ve - z
A
s
y;[r Otlier Agency Operation Reviewy w
JjR_Routine 0 Complaint 0 Follow-ue of DWQ ins ection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection 7ky Ili
Time of Inspection `- a 24 hr. (hh:mm)
Permitted [3 Certified ❑ Conditionally Certified 0 Registered JE3 Not Operational I Date Last Operated:
Farm Name: ........... do5 ........... County:........ 64VN
OwnerName: .............Do•rhy........C-w.................................................................... Phone No:.. ....��kl �.. `a rQ.s`o.-.............-............
.....Title :.............. Phone N o• �q 9 `1Z1S
Facility Contact: ....................................................................................................................-..-.. 'v........�..�....`�:-..-.....................
MailingAddress: ......%I—A.......�)u.cc� t...�-............................. I ............... I ......... ....... ....QiP.nau....... Nr.............. .-..............-........-... � 2119K.......
Onsite Representative: .......... bts t C-0 Integrator C5 c7d 41 5...............................................
Certified Operator : ................................ ................... ....................................... ...................... Operator Certification Number:..........................................
Location of Farm:
Q.....5........i. I�. d tta l s.....�5 .......c�..............(.G'..
r...... Ss T.............:.--....-........-.....-..................-...................... —I
................................................. ............................... ...................................................... ..................................-
Latitude Longitude
= =' Design Current " ` Design Current Design Current
Swine Capacity Population .' Poultry_ `Capacity Population Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
y -Lp
43 IQ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
v-
iNumber of:Laioons.• ji❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holchng;Ponds / Sotid.Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes [PNo
Discharge originated at: []Lagoon ❑ Spray Field [:]Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes] No
c. If discharge is observed, what is the estimated flow in gal/min? ),Ilk
d. Does -discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes (] No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
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): .............. 9.y]�............. ........... ..................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes g) No
seepage, etc.)
3/23/99 Continued an back

Facility Number: ?j1 — RL Date of 1itspvction
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 gover application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13_ Do the receiving crops differ with those designated in the Certifi
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?
Animal Waste Management Plan (CAWMP)?
Re uired Records & Documents
I7. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Nd -Yiol'atioris'Oe- deficiencies •vt�ere potted• dix iAd this;visit: - You will •eeceige iiti l'ufth&
c6rres�6fideilce. maul; thl"S visit_
Comments (refer. to
.questio
Use drawings -of facility to'l
-etter explain situa ions'. usi additional- pages as' necessary
5r^Alt Vekir,, J-o %ertnUje_
a �trJ 4o I,& 0)A
�_Nca
Reviewer/Inspector Name [_'�:
Reviewer/Inspector Signature:
COMPW� cA- GJA- �c�rmi rto,,.
❑ Yes No
❑ Yes 29 No
❑ Yes P No
❑ Yes q No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes (M No
❑ Yes ® No
❑ Yes W No
❑ Yes 0 No
❑ Yes No
U Yes ❑ No
❑ Yes [P No
❑ Yes 00 No
❑ Yes [P No
❑ Yes [d No
❑ Yes [P No
❑ Yes 0 No
uixrucs._9 -
"hl —_ Date:
3123/99

'Facility Number: 31 — 9(. Date of Inspection Z3
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ( No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes] No
roads, building structure, and/or public property)
29_ Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [A No
30_ Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No .
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes VNo
3/23/99

i•
Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
Routine O Com laint O Follow-u •of DAV ins ection O Follow-up of DSWC: review O Other
Date of Inspection ��
Facility Number 31 Time of Inspection , 3:t70 24 hr. (hh:mm)
13 Registered 18 Certified © Applied for Permit Permitted 113 Not Operational Date Last Operated: •-------
FarmName:...........%ap k,.......5.r,, AL ....................................................................... County:A....... 41111_...................................... ............. I.........
OwnerName:...... han .............................. ..........c9c<.............................................. Phone No:.... . ............................................
FacilityContact: :..................................:.......................................... Title Phone No ...................................................
MailingAddress:...........btE 7(!sCtts.-........�t1. ...:.......... .........
w6lAtl�?;..._N'q.$..........
Onsite Representative: ........ bcLY1Yl. .-.------�It�..+.�...---.-.-.
4
Certified Operator— lr
..... ...............
Location of Farm:
Integrator:...... YY4...........................................................
Operator Certification Number;.---...6•-
1?n.....1!! a......:.....'s ......c ...... ,...i.S6....�-...Q :. .r�i�s s •cam. -...off..--- CK-.t ......:..........................................................................:..........
...... ..-- .. -.............................
Latitude Longitude ©• ©' �"
General
L Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
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
niai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ® No
❑ Yes M No
❑ Yes No
❑ Yes No
N jAr
❑ Yes 09 No
❑ Yes ( No
❑ Yes No
❑ Yes No
❑ Yes 19 No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes U No
Continued on back

t
Facility Number: 31 — Oki,,
8_ Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoop.s.11olding Ponds Flush Pits etc.
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
.Identifier:
Freeboard{ft}: ...............3 :Z................... ................ ...................... ..............
10. Is seepage observed from any of the structures?
1 I. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes +Q No
❑ Yes W No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any or 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)
I5. Crop type ......... 1Cl A...................................5. ��._.. ltti....._..._...................................... ..............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Qpl r
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'?
0 No.violations or deficiencies vere'-note'd during this.visit..You will receive no further
correspondence about this.visit.,'
0 Yes P9 No
❑ Yes jgl No
(M Yes ❑ No
❑ Yes Q No
❑ Yes ® No
Yes 0 No
❑ Yes E No
0 Yes ❑ No
❑ Yes IN No
❑ Yes 'M No
❑ Yes 1�1 No
❑ Yes 10 No
❑ Yes ( No
PYes ❑ No
90 Yes ❑ No
Comments.(referto.gaest;on #) .., Explain any ITS answers and/or'aiiy recommendations or any otherrcomrnents
Use drawings of faeility-b better explain'situations.'(use additional pages as necessary}
�Z- Ccm4cn+� z��s }t} t�es�et) bare. �s o� 1a�ear. d;v..c ►aa.11,
16. i,o,..�:raUe. e.��� �o i�.� loerr►.u�a.
7'`�•Izs-. M:Y.e�r u ���I.r-�ioh o� tt��rio�v., �Czsl�s fa.r.
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: �4 �1 Date:

':i'C 1}i ill�hl'C�i(1fl
Facility Numhcr
Ti???k' (,I .o?Spl'C'INIn � 24 hr. (hh:mm)
p Registered M Certified p Applied for Permit E Permitted a Not cratlona phate Last Operated:
Farm Name: OQshEn.SSuine.................. ............................... County: Duplin WIRO
Ownerflame: Danny ..................................... C:aopc.r............................................... ......... Phone No: ..........................................................
Facility Contact: ................................................................... .......Title: ....... Phone No:
Mailing, Address:.4.24.B1arkmctre..Rd.............................................................................. W.arsan:.NC........................................................... 28398 ..............
Onsite Representative: .......................................................................................... ............... Interrator:f: artall`.S..1r.ouds.JmA..........................:..................
Certified Operator: Dart.ny..T................................ Cmixer .............................................. Operator Certification Numher: 1.7.186............................
Location of Farm:
Latitude ©a ®1 1,Longitude ©0 ®4 ©«
esign Current
Swine Capacity Population
pWean to Feeder
® Feeder to FimsH
❑ arrow to can
❑ Farrow to Feeder
❑ Farrow to Finish
p Gilts
❑ Boars
esign I—Urrent
Design urren
Poultry Capacity Population Cattle ."_-- Capacity Population"
p Layer
❑ Non —Layer
„ --
p ter .
Total Design'.Capacity 4,32=',
Total'SMW 583,200
1/29/98
Number ofLagoons:/.Holding Ponds I Llo Subsurlace Drains Preseni n agoon rea p pray ie tea41
_ = ❑ No Liquid Waste Management System _
General
1. Are there any buffers that need maintenance/improvement? p Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originaicid at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is ilhs r, t:d. u:ls the convevance man-made? ❑ Yes p No
b. Udischaroc is obs r vd. slid it reach Surface Waler? (lf yes, notify DWQ) p Yes p No
c. If discharge is ohscn ed. what is the estimated flow in i-,al/min"
d. Does discharge bvpzlss ii iaaoon 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 ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require p Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? p Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? p Yes l] No
7/25/97
Number ofLagoons:/.Holding Ponds I Llo Subsurlace Drains Preseni n agoon rea p pray ie tea41
_ = ❑ No Liquid Waste Management System _
General
1. Are there any buffers that need maintenance/improvement? p Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originaicid at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is ilhs r, t:d. u:ls the convevance man-made? ❑ Yes p No
b. Udischaroc is obs r vd. slid it reach Surface Waler? (lf yes, notify DWQ) p Yes p No
c. If discharge is ohscn ed. what is the estimated flow in i-,al/min"
d. Does discharge bvpzlss ii iaaoon 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 ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require p Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? p Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? p Yes l] No
7/25/97

a �
r
Facility Number: 31-96
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lag_oons.Holdin2 Pnnrlti. -f tu•.t: Pit,,. ctc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I t�isucturc 2
Identifier:......................................................................
Freeboard (ft):
10. Is seepage observed from any of the structures?
Structure 3 Structure 4
] I . Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
I3. 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 (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilitir• 0,,Iv
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?
11.�V_-viqlations.or iciencies,were.note nnngt rsvisit. nm� further.--.
.receive no uer.-.
ex~> es�ion�ene� a4Qut t�iis i �s� :: . . .
isit was made to assess if facility is a likely candidate for State groundwater study. Ubservations of spray
om public roads.
)ray fields were dry.
o occupied houses or wells were observed near spray fields. One abandoned house was seen across road.
p Yes 13 No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
13 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
p Yes p No
Yes p No
p Yes [3 No
were
712519, I
Reviewer/Inspector Name 'And"rew.:G•Hclnir
Reviewer/]nspector Signature: n
Date: Z

M
form pom
N32-
.
S82.04-34
g�4t.88
1SF
66
4.07Ac. OM�
�LEC.72
AL . WETLANDS
2e9.79 0 —• .. --
A, tt� d +� j•�$
Q l0r,3
'r
58:12-03i�914$
24 8 t 91.
, i ;•.r
a
Cat
i
872Aciti.
M ✓ -z _ ICI(
>~H. 568-44-29W
•,q.�i5r :.. _ Fl12-C)5-5E3 W 184.!i$
55-57`:-_�— fti 13-19-z6 vi 22E.�5
N.9-39-44 W 219- Qb
',g.6i�r-.....
N 8 - 1- 32 W It 6. CA c
61-63!
r:30-28-34 W 86.2G
VI 161,3'
106.8e�
164 -69

'=30 Division of Soil and Water Conservation ❑ Other Agency''
LL:
El Division of Water Quality-` ..a,• 5 ,,A?"."..'.c„°45X3s?6" r U,r,:;"�"t"n '�'33't°k.- -. rce,sen.'4i ��', "';�--.:.�:.,. '„Z: �7,?�?'N",°,�&'t4o'.,
OLRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Fotlow-u of DSWC review 0 Other
Date of Inspection t qi
Facility Number b
Time of Inspection i 24 hr. (hh:mm)
© Registered ® Certified [3 Applied for Permit 0 Permitted 113 Not Operational I Date Last Operated: .........
Farm ,Name: ... .C........6.t.11.r-^.........
w..a.... County:..D"A.TA5..r�................................... .ki..Lp
Owner Name:..' :.! f-. _ ........ Phone No: t. 1112�..(�,�$ .. .9. .�..55 .........................
FacilityContact: rTP.Aran....&..I?u.,�.'�-�j.. .A. Title:................................................................ Phone No:...................................................
Mailing Address:..$��.......N........................... ... .:.... . i..5.. f...... 0C..................... .. � . .
Onsite Representative:...D.;.t.d'r..... ...../ a ra �r ,......C-44.-........ Integrator:... a.r r4. 4.4...5....................................
Certified O erator-_Di m., i ....G,. anpe.il................................................ Operator Certification Number•..1. ..........
Location of Farm:
Latitude Longitude =• ®' ar ]
Des Current Deli Currents DesCurrent
Sw�te: Capactty�Pulatioar tT PoaItiy Capacity �Papuliiktion Cattle > �CapacxtyNPvpulataon a
❑ Wean to Feeder ❑ Layer g ❑ Dairy
Feeder to Finish ❑ Non -Layer € ❑ Non -Dairy
❑ Farrow to Weans 6> a OR r rG z
❑Farrow to Feeder ❑ Otherf; k
y < ', d:,
❑ Farrow to Finish b x - Total<DesignCa�acity
NOZ
ota1SSLW 2
ff Gilts
❑Boars s ` .� � � � �
Nnmlier of Lagoons ! Holdutg P nds ❑ Subsurface Drains Present 110 Lagoon Area JE3 Spray Field Area
a
..... ....... . .....
x
❑ No Liquid Waste Management System ,x.
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ®'No
2. Is any discharge observed from any part of the operation? ❑ Yes SNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ERNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gallmin? ,ac
A. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [X No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
5jNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
CKNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
JS No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Eallo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
E!lWo
7/25/97
Continued on back

r
Facility Number: —
!.�
T� 8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
M No
Structures (Lagoons,11olding Pouds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
kNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: &.2.S............ ........
Freeboard(ft):.................................... ...... "" ............................... .............................. .............. ...................... ........ ............. ...............
..... ............. ..................
10. Is seepage observed from any of the structures?
❑ Yes
ETNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
®.No
12. Do any of the structures need maintenance/improvement?
[ .Yes
❑ 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
1[ No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
ENO.
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type nrz ....................... �Mu.�.�;.q. i. ...................
16. Do the receiving crops differ with those designated in theAnimalWaste Management Plan (AWMP)?
❑ Yes
QNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
93-No
18. Does the receiving crop need improvement?
KLYes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
RNo
20. Does facility require a follow-up visit by same agency?
❑ Yes
1R No
21, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[HNo
22. Does record keeping need improvement?
❑ Yes
EZNo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
1RNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
RYes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
Sc No
0-No.violations-or. ddkiencies.*ere->Roted-during this:visit.- You:will receive-no-f irther-: -
::�correspondenceabautthis:visit:: - .-...•:.•-�.�:. .: .�:.•.•.:.:: .•: .: :•..-::. , .•
1 Z- F-9-- �e,+vL J-.e . G_^r b o- r-t S r o i t l c %, o o� w a t t
1!� . W 0 / 0*,r1 V 0 L
4A S r-�0.1 4- i i r� C,(iv { o G +^ ' „► al
was ! e t o .�.. , �`j,►, J� . p ~wnJ -1 k-o V La VX a' +( c. � 0.1
0 R �z-e c..At _r d t—a v 4L 4a- f
1Je t4 tt o� JP c i ems, w; 11 1ae' S -C 4-" V,-+
c-e — t-; �' $ ta.,•. ( J
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: ^_, , JI z I Q n Date:

Site Requires Immediate Attention: 1I C3
Facility No_ 71 - 9
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE= , 1995
Time: '100
O
Farm Name/Owner:
Mailing Address: `dJ i't C
County: -
Integrator: Cc,_A4,t a! I r — Phone: Illqj Ca3-,o._ LH-j
On Site Representative: Phone:
Physical Address/Location: 2 a-e1) O
✓L c) c_ J—
Type of Operation: Swine L-1 Poultry ' Cattle
Design Capacity: !S! at)' (� Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 S " 03 ' 5'4- 3 Longitude: 7 St° ' a9 9" Elevation: Feet"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) e or No Actual Freeboard: S``f Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or Vo Was any erosion observed? bYe-or No
Is adequate land available for spray? 'e or No Is the cover crop adequate? 1e or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback
? 200 Feet from Dwellinas6 or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or XUo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o16) 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
r A
Additional Comments: ,xLJ
Inspector Name
Signat e
cc: Facility Assessment Unit Use Attachments if Needed.