310099_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qua

r/
.. .c 1vislon ofWater�Resources
�;�� y c'++fi � r r roc .r.y. `" ����
Facility Number !�� �QDivis�oa of Soil sotlWater Conservatron ;erg
�r Other*Agency
Type of Visit: 7tutine
nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1I Departure Time: !J County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: { snfV, L T
Certified Operator:
Back-up Operator:
Location of Farm:
Design Curren# `
M
Swine Capgcity Pop Wet°
Wean to Finish: La e
Wean to Feeder Non -
feeder to Finish
Farrow to Wean"
Farrow to Feeder :f;ZOO
Farrow to Finish La e
Gilts Non -
Boars Pulle
Turk
_OtherI ITurk
Other
Latitude:
Poults
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 1 a 7,0 1-3
Certification Number:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai ^`
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0<0 DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes Ef'No ❑ NA ❑ NE
Page I of 3
21412015 Continued

Facili Number: - Date of Inspection: Lf Z 4-7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [-'Ro ❑ 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: 3 7`
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 2 6 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E2-1 ❑ 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
CyNo ❑ NA
FINE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
&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 Io ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Wo
❑ 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 Fj No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rNo❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA 0 NE
❑ Yes E40,13 NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes N .❑ o _ ❑ NA ❑ 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:
2 L 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 E31 ❑ 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+ lumber: 7 1- Date of Inspection: 2 Z
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 [�' 1�❑ 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? 0 Yes ❑`lam` ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑-1 AA^❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes t o` ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes �^ ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑_Wcr O NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
—NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�i ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q-Ni - ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
No ❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
f
r u
1�
f--7
Phone: C 7r l
Date:
E:z r l-'?
21412015

U Division of Water Resources
,.facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Co pliance Inspection 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: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Integrator:
Certification Number: 7 ��
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
W an to Feeder
-'Feeder
to Finish
30
2- 1)
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Soars
Other
Other
lets
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA 0 NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili umber: - Date of inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 Rio ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EJ`No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EfNo
❑ 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
L_J No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[? No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q-lo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2 go
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
E:rN_o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
[3-No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

a
Facility Number: jDate of inspection:
24"Did the facility fail to calibrate waste application equipment as required by the permit? Yes LJ 1"� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No (�KA ❑ 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 CAW -DP?
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 E rNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E rNo ❑ NA ❑ NE
❑ Yes
No
[DNA
❑ NE
❑ Yes
[JNo
❑ NA
❑ NE
❑ Yes
❑ Yes
WN
❑ NA,
❑ NA
❑ NE
NE
__.-r______---_____ v - -_ _ L _____. _ - --____. IIV - Y.-' r
Reviewer/Inspector Signature: Date: Vj(S__ S-
Page 3 of 3 21412014

U Division of Water Quality
`Facility Number❑ 0. Division of Soil and Water"Conservation 7 y
0 Other Agency
Type of Visit: Com ante 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:% q�' Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: We 1 1 � ��✓ r G
Integrator:
Phone:
Certified Operator: Certification Number: Q
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
Certification Number:
Latitude: Longitude:
Design . Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
F[Layer
Non -Layer
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)? _
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?
Cattle
Design ryCurrent
Capacity�-Pop
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑'I o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes . ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 7,1 -_I I I Date of Inspection: /F
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C_7 :emu ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: L Z� L r) L 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E]"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 25"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 �o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes El"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 ErNo
❑ 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 Q To
❑ 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
Yo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ WE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes rNo
❑ NA ❑ 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. Ws No ❑ NA ❑ NE
❑ Waste Application ekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking rop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes elNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E"No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Plumber: - 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 [31No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No 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)
❑ Yes ENo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
[:]Yes ENo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below, ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
drawings of faci v to better explain "situations'(use additiona
L'"No ❑ NA ❑ NE
Ef'Noo
❑ NA
❑ NE
El�o
❑ NA
❑ NE
Er-N-o
❑ NA
❑ NE
7 /Z,6//r I~5f a� . S� f� S�a►�
O
C� e
` ntvA
bilk, � 004
�13so Z
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: f 71 V �0t
Date: s Ll S
V4/20I4

Division of Water Quality
Facility Number ©- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: P<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Qrkoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: W
Arrival Time: .' lj3 Jh
Departure Time:
County:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Region:
Facility Contact:
Onsite Representative: Pr e
Q Title:
. LJ�MkI
Phone:
Integrator:
�
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
:Swine Capacity., Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Non-L,
Pullets
Other
Puults
Longitude:
Design Current: '�
Cattle Capacity -Pop
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [-]Yes FfNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes [:)No
❑ Yes ZNo
[:]Yes 01 No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 1"7, jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ N-A ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PTNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i. X•-
Spillway?:
Designed Freeboard (in): i q t Q
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 eNo ❑ 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
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ 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 [;a No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
V No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra/ nsfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �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

k'hcili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 07No ❑ 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:
25. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes ,6 No
❑ Yes 7 No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 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).
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 3 1 `I
21412011

0 Division of Water Quality
Facility Number ®- O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance inspection Q Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: GrRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: f Arrival Timer Departure Time: County:T Region:
Farm Name: MADIP,RoN_Aj [YWS Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Integrator:
Certified Operator:_IA416&'_11 �!(`��a� ��13ptnj�l1n Certification Number: `{
Back-up Operator:
Location of Farm:
Swine
can to Finish
can to Feeder
zderto Finish
.crow to Wean
.rrow to Feeder
rrow to Finish
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Non-L
PuI lets
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 Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 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 KI No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [:�No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 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 E!fNo ❑ 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: ptj q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 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
XNo
❑ 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
[6No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ rNo
❑ 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
[ZNo
❑ 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
[5No
❑ 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
[allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ID es
�TNo
❑ 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
[a"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ErNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
T[ TNo
❑ NA
❑ NE
the appropriate box.
❑WUP [—]Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ETNo
❑ 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 ZrNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [!fNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility -Number: JDate of Inspection: —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E5No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [::]Yes FTNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
]�No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
Ej­No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ff No
❑ NA
❑ WE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
TNo
❑ 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
[!I No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments -
Use drawines of facilitv to better explain situations (use additional naves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �� a
Date:
21412011

Division of Water Quality""`
Facility Number - ® O Division of Soil and Water Conservation
O Other Agency�����
Type of visit: Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Izeason for Visit: "o Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: EK= CountyRegion:
Farm Name: i 1 'ADC.-C RU,V FPk- .(y\S Owner Email:
Owner Name: IL �2.w1C1C Phone: q lo- 96- 1 QD R(
Mailing Address: ?440 ��-17CQ_ UJV 1L.L_j f) mS �-E f4N S U I LLE , AIC a 8 3Lft
Physical Address:
Facility Contact: Title:
Onsite Representative: ��1C_ QI.JIC
Certified Operator: ED L)CK . _ L� )(7-L .1�-
Phone:
Integrator: y �\
IDL
Certification n Number: } 3 U
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.
EllL
ayer
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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:
Cattle
'Design Current',-"
Capacity Pop,.:. -
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes W No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [:]No
❑ Yes 0 No
❑ Yes P No
DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: 1 - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes JJJ""❑No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: J D_ r
Spillway?: nn Q
Designed Freeboard (in):`nl , qs
Observed Freeboard (in): O� J s GEC 1
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 jj No ❑ NA ❑ NE
waste management or closure plan? J�
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 structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes PkNo ❑ 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? 0
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PkNo ❑ 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 p❑ Application Outside of Approved Area
12. Crop Type(s): 52 + Rpz� Telpe(_ t u-6 -rT
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?
❑ Yes No
❑ Yes No
❑ Yes 0 No
❑ NA 0 NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required _Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
0
❑ NA
❑ NE
the appropriate box.
0 WUP []Checklists Q Design 0 Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
D Waste Application [] Weekly Freeboard Q Waste Analysis 0 Soil Analysis
[3 Waste Tr sfers
0 Weather Code
0 Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections [] Monthly and 1 " Rainfall Inspections 0 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 Ins ection:
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.
0 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 77❑�� No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes jj No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 77��
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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No
❑ Yes No
❑ Yes ONO
❑ Yes o No
❑ Yes (2f No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21412011

Facility Number
Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up (:)Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 15 }5�/t� Arrival Time: Departure Time: County: O Region:
f�f�
Farm Name: Y +�l OC E Al FAQ-(r) S Owner Email: I
Owner Name: / V � I L AQw10(1 Phone: 510 _ c(96— 10c0R_
Mailing Address: ba--lame- V6 ��rsuiu-E f /.Y1n CLAD 3 —ffW
Physical Address:
Facility Contact: n �^ Title: Phone No:
OnsiteRepresentative:
��', `C!L e(�)GL Integrator•
Certified Operator: r �l� � / Y - RA2w7 Op%tor �rtification Number:
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
Back-up Certification Number:
Latitude: =]' =' =" Longitude: = 0 =' = if
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
— -� ❑ Non -La et -
Dry Poultry
Pullets
Faults
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

I
acilityNumber:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I St lure 2 Structure 3 Strugture 4
Identifier: L
Spillway?: nn
Designed Freeboard (in): o� 1�nr� C�� n�
Observed Freeboard (in): o� 4 9 O!
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 1
�No
ElNA
ElNE
❑ Yes ❑`No
❑ NA
❑ NE
Structure 5
Structure 6
❑ NE
❑ Yes �}No
❑ NA
❑ 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 `� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IXNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O(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?
I I . 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 ❑ E{vidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) � & �T� � 1 "q- L- M 1 L(_ &']T
13. Soil type(s) 1 jL4-jC AU
14. Do the receiving crops differ from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5No
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
Comments (refer to que4i6it #}: Explain ariy YES answers andlor any recom nendations or any;other comments a
Use drawings of _facility to better explain situations..(useadditionahpages as:necessary).
Reviewer/Inspector Name
Phone: 110-_496-*-�
Reviewer/Inspector Signature:
Page 2 of 3
..OEM
12128104 Continued

Facility Number: '3 j — r-�' Date of Inspection
Required Records & Documents �f
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes QSI No El 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. 0 WUP 0 Checklists E] Design [1 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ ¢�nnual Certification
[] Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections El Monthly and 1" Rain Inspections 0 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? (iel 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?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
P�No
ElNA
[3NE
ElYes
❑ No
OkqA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
P(No
❑ NA
❑ NE
❑ Yes
ViNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
'o
❑ NA
❑ NE
Additional Comments and/or Drai •in s:
U6IAI7ICW 1J� �O11
L.U..
Page 3 of 3
12128104

r
Facility Nufliber
F
D'vision of Water Qual<ty ,
Division of.Sotl and WateraConservation
Type of Visit Ocompliance 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: f Departure Time: County: i �LtQLI JV Region:
Farm Name: 1 to � "D UE 6-LA/4 CkLm S _ _ Owner ICEmail: Q
Owner Name: /,!S_ _IJ�� 1� n
Phone: `110_9q�Q— )CDR
Mailing Address• s. I_4d U7i Lt`.H9Mc,4 V_J I�EA14)V SULLLC- 11V(2plE3clq—,RE-Sc'
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: Gee Gy", A e�)AGL LOIGC-,
Back-up Operator:
Location of Farm:
Design
Swine Capacity P
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish Lf36X5
❑ Farrow to Wean
Phone No:
Integrato
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f Longitude: = o = A
Current Design C
opuration 'Wet Poultry Capacity Poj
ILI Farrow to Finish I 1 11
fl Boars f ��
Other
❑ Other
ILI Non -Layer I I
IDry.Foultry,
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey 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?
Dairy Cow
Dairy Calf
DairLHeifer
D!X Cow
Non -Dam
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 No [DNA ❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes NNo ❑ NA ❑ NE
❑ Yes )ANo ❑ NA ❑ NE
12128104 Continued

FAcility ?lumber: -- C
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1 � a T_� 3 ucJ
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
l r � T I r ✓� 1 J r
O
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 )ANo
❑ Yes ❑ No
Structure 5
El NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes �qNo ❑ 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 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 ❑ NE
maintenance or improvement? A
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X
NoElNA ❑ NE
maintenance/improvement? ONo
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [INA ElNE
ElExcessive Ponding ElHydraulic Overload [IFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
[:)PAN ❑ PAN > 10% or ] 0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ ApplicationOutsideof Area
12. Crop type(s) A I LrL c T I L P)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
KNo ❑ NA ❑ NE
1Z No ❑ NA ❑ NE
.Com ni, ents'(refer to quesdow#) Egplai6itin} YES answers and/or any recommendations or any other commen ts.F
Use drawings of facility to better'ezplain situations. (use:atlditi6hal pages as necessary): e
Reviewer/inspector Name
m{}II�Q�!✓}IS ar ;;� Phone:
Reviewer/Inspector Signature:
Date:
r
Continued

acility"Number: 3 — CIO Date of Inspection l (S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box.
ElWUP El Checklists [11 Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )�No ❑ NA ❑ NE
0 Waste Application Q Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ �nnual Certification
El Rainfall ❑ Stocking ❑ fCrop Yield [] 120 Minute Inspections El Monthly and V Rain Inspections /0 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 G•omments and/or Drawings:
1
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
10No
❑ NA
❑ NE
❑ Yes
❑ No
�NA
❑ NE
❑ Yes M No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes k No
❑ Yes 0,No
❑ NA ❑ NE
El NA El NE
❑NA El NE
❑ NA ❑ NE
El NA ❑NE
El NA ❑NE
12128104

Type of Visit 4 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Ipt /y/Q`7 I Arrival Time: ® Departure Time: County: LI� Region:
Farm Name:�M iqc (� E l _!2xAt Fp4q-a) s Owner Email:
Owner Name: / y -- I L l?NggtLX31_�1� ___ Phone: cl/d -9g0!�P -1oa & '
Mailing Address: SL) Q Q, i A��I u_l A „-
S 8 E> t WSU1L-1-.E(y ..�c OSJ`"t
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:��}1 �{_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 = Longitude: = ° = d =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
4300
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ TurkPoults
❑ 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
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: El
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ANo ❑ NA ❑ NE
El Yes
❑No
El NA
El NE
El Yes
❑No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes XNo ❑ NA ❑ NE
❑ Yes qNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection y d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 5-1-9 LI
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? NA NE
(ie/ large trees, severe erosion, seepage, etc.) ❑Yes No ❑ El
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 14 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
J(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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window) El Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) s) (
— j e `L G j� { 1 P Ed@�Q= L__ m f LLI` TT �� )
13.
Soil type(s) I U_&
14.
Do the receiving crops differ rom those designated in the CAWMP? ❑ Yes
20 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
R No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
J" No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
o
ElNA ElNE
t8.
Is there a lack of properly operating waste application equipment? ElYes
rNo
❑ NA ❑ NE
L
er/Inspector Name N Phone: 9/0 '�ti "430[7erllnspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: S1 — 94i Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
XNo
❑ NA ❑ NE
the appropriate box. ❑ WLiP ❑ Checklists [l Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑/aste Transfers
❑/nnual Certification
0 Rainfall 0 Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and V
Rain Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Wo
❑ 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
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
4No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
\1�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[IYes
No
❑ NA
❑ NE
Page 3 of 3 12128104

ID Division of Water Quality
Facility Number `� j q 0 Division of Soil and Water Conservation
0 Other Agency 11
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (R) Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: Departure Time: County: A/ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: _ d E I L A2w iC.K
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:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: a o = ` =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poutts
❑ 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 Stockei
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ;Q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
�j No
❑ NA
❑ NE
12128104 Continued

Fagility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1Z 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: L,4(_ccN 3 4160W 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): tp9 a 1S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E4 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
M 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
50 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Pq 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
[KNo ❑ 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
RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or l 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IRI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I'F"I 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):
L
er/inspector Name NN tq� suL Phone: 9 j d- `� (D �3��erlinspector Signature: Date:
12128104 Continued

1
Facility Number: 3 Date of Inspection 1 a
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 El No ❑ NA ❑ NE
the appropirate box. ❑ W`Up ❑ Checklists ❑ Design El Maps El Other [A
No Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
91 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[� No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fait to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
CRNo
❑ NA
❑ NE
Comments and/or
12128104

[' (�
Facility Number
.O Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit gRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 Off] Arrival Time: % Departure Time: ; O County:
Farm Name: �1/// �L,� /1 tr''V &L, �"� _ Owner Email:
Owner Name: /UF_ ZG A" _ Phone: _
4
Mailing Address:
Physical Address:
Facility Contact: Q Title:
Onsite Representative:
Certified Operator: ' " �, zL JL�=
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:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = . = Longitude: =° = 6 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I❑ Non -Layer
Other
❑ Other - - -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: FW]
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes Ifs No ❑ NA ❑ NE
❑ Yes /� No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /PlNo ❑ 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): 960 Z5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ElNE
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 ZoNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PTNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑l Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) �f.2.r1uD,4 � A2>G� J� �• 1QU1�S
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes XNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes qNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 0 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes �ZNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes E3'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):
/9') lb1x.`,o �o Lpcs�
`r J`y.✓o
Reviewer/Inspector Name �,�C� �,c� T T Phone
Reviewer/Inspector Signature:
Page 2 of 3
Date:
Cq�oL�9�-7327
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? PrYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RfNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ANo
❑ 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 XNo.
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes A No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �Z(No
❑ 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 gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes �No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes0No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes Ld No El NA El 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 El 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 ;IrNo ❑ NA ❑ NE
Page 3 of 3 12128104

C
Facility Number u�
I@ Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 10 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: Arrival Time: Departure Time: County: W04�.ZAI Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: j Title:
Onsite Representative:
't N
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No:
Integrator: 2do.1
Operator Certification Number:
Back-up Certification Number:
Latitude: = o= 6 Longitude: = 0 0 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ 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 l of 3
❑ Yes X
No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes X No
❑ NA
❑ NE
❑ Yes x No
❑ NA
❑ NE
12128104
Continued

' Facility Number:.,q Date of inspection ! a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
El NA El NE
Strugt,qe I S c re 2 Struc r 3 Structure 4 Structure 5 Structure 6
Identifier: '� '
Spillway?: fl�io A40 /00
Designed Freeboard (in): /7 l9 38 lq,
Observed Freeboard (in):
❑ Yes �Z No
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Jam-' 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 A 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? 1 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PdNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste 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 W' do w ❑ Evidence
of Wind Drift ❑ Ap licationnOutside of A a
12. Crop type(s) �,�„ �,u q_ ��/Z ZI�I. U . [ �!%f %LS��2 / tiGIQa9��/�
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 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 ILJ 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):
- P�-'!'f_ Fa0 m �tZ G��pa.✓ � �`3 G.� �o a� �,E�� 5 � ,� �-��� .SucN T .ter
Reviewer/InspectorName S?F_D� BAR Phone: /d Zlo
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12128104 Continued

iJ
Facility Number: Date of Inspection 3 / O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J6 No ❑ NA ❑ NE
the appropriate box.
❑ Wi1P El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 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
to No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
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
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J0No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
0 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
Y, No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings: QR ~ve
f/ ,,� ,, //
GUZGt /7VF /�lD,QF_ Q�✓�j�O�G��� lti'�I� G�'y'�%G� GS%FOCl�c{'ri
17�iQGzc ii �'za,�5, �.�,� ,,5�2��6� ��✓��s�s � �Z�J�'.5/
Anzo
0 0 �/ A C15 40.
ate
�s 910 ,354_2004.
ao o0
H,
Page 3 of 3
12128104

OM :BARWICK FAX NO. :9102966031
Jan. 302006 04:02PM P1
Celcf �'4 e-4
0) P;� ui, �k

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FORM 1RR 2
Field Size (wetted acres) = (►�
Farm Owner
Owner's Address
(1)
Owner's Phone #
Lagoon Liquid Irrigation Fields Record
One Form for. Each. Field.per Crop Cycle
3771: - Field # 7
4.95
Neil Barwick
3407Dr. Williams Rd,
Kenansville -NC.2.83r49:
910-2$6-1028 .
>. Facility Number 31 - 99
I'Mg adori Operator Neff Baitiwi*
Irrigation -Operatoes 340-Dr ".W1tW0Z0-
Address: Ken rlsville . NC 28349
Operators Phone #910,2W'10.28:•. -'
F 1Ne�e Mlizalion Plan
Crop Type , : Recommended PAN 235
CB Loading (Ih/acre) = (B)
(2) MY, (41 is) !Bl M (81 (9) (101 (1ll
(mmldd" .:
Waste Anaysls
PAN*
0b11000 gel}
PAN Applied
(Iblacre)
to) is (M
loco
rldrogen
Balance"
(Iblacre)"
(e) - 00)
Start,
Time
ErW.
Time :
tote! , ..-
Minutes .:
(3) - (�)
. - _. f df
Sprinklers :..-:._,Efate:
Operating:::.
._.,Flow ' _
OaUmin)
. Total Volume
:. (gallons):
(6) x M.- (4)
per Acre
:. (gairacre) ..
... (i ! (A)
B= 235
�J1105
8:
4:
480
"f ..1
_ .:.,t9$
95040
19200:00
- -:2;2
42:24
192,76
`:.. 6;P2105
9:0�
5:00
:: ' 4$0
" :: 1
::. 1$
95040
19200:00
, `2:2
: - :- 42.24
:158, 52
=. 716105
7.3Q
' . 3:30
.480
.- .=. �1
:::. 9. 8
:: 95040
19200.00
2.2
42.24
: :: :. 108.28
:: 7i►sit
t3:00.
4:00
4eD
.
.. _ ...
: ...
9504D
' - 19200.00
:. 2.2
a2.24
86.04
a i 66,
8:00
:. 4.00
- - 480
1$8
..-._ 9500
-19200.00
:.' . 2:2
42.24
23:80
=8/1 BJ05
7: ' ;
. .. 3:30
:: 48Q
...... ; . 1
:. -1 t� .:
- . ~ .. . 95Q
... 19200. 00
2.2
..: 42.24
-18. 44
p Cycle T
.. - ... ...:Orod>a>s -670M-. .. _ .. .... -
Ownees Signature Operator's Soaftm
Certified Operator (Print) Neil Barwick Opefatoys CerMcation No. 17370
NCDA Waste Anaylsls or Equivalent or NRCS Estimate, Technical Guide Sedan M.
Enter the value received by subtracting column (10) frem (B)_ Cordtnue subtracting. column (10) from column (! 1) fallowing each lriigalion event

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FoRm IRR-2 *
Tract 0
Field Size (wetted acres) = (A)
Farm Owner
Owner's Address
Owner's Phone
Ligoon Liquid irrigation Fields -Record
-.-One 5orm for. Each Field per Crop -Cycle
$771 - - '. I - - - Field
4.95
Neil Barvftk
340 [W.Vilfianwft..;
LKeinia sville, NC 28349,:
1910-29&1028.. -
'Faclift NUMW :311 291
irrigation Operator Neil L.arwu
Irrigation Operator's 1340-Dr.Wfiflarns-Rd-
A '
, ddf6gs KMAnavillo; -NC,28349
Opera0rs.Phone#,010,qW1-0L6.'_-
"FirmMaMe Udftatkm'Plan
Crop tipe, Recommended PAN 235
CE Loadirg (Iblacre) (B
(11'. (2) (3) (4) (61 (61 M (81 (9) (101 (111
Date
{mrn/Ad".
•
an
Wasta'ArtalWs
PAN*
lb/ IWO gal)
PAN Applied
(lean)
f8lx(41
1000
Nitrogen
Balance`*
:Mlacre)
M-00)
SW
Time
-End
Thm,
Total
Minutes
(3)-(2)-
.$Of
Sprinklers..:.
OWetling
flow.
Rate'
(gaftin)
I Total VolUrne
_­(galws)
(6) x (5).x (4)
Volume
per Acre
(gava")
M /(A).
B= 235.
613/05
8:00
4:00
.480
1
196
95040
19200.00
'22,
4214
192.76
E6105
9:00
5.00
480
1
198,
9SD40
19200.00
2.2
42.24
160.52
717105
7:30
3:30
1
198.�
95040
19200.00
2.2
4224
-A 08.28
-7/8/65
8:00
4:0 01
480
1
198
95040
19200.00
2.2
42.24.
.86.04
-8/11/05
8:00
-4,
.-48o
i9a
95040
19200.00
2.2
42-24".,
­23.80
7:30
.30
3:1
-480
ISO
95040
19200-00-
:.2.2
42.24
.18.44
I
L
LAI: I Irm - .. . . - - . _` I _- 67024 crop Cycle Total(.. 01.
Owners Signature Operator's Signature
Cwflfed Operator ('Pr1nt)'Neil' 'Barwick Qp.erat&s Certification No, -17370
NCDA Waste Anaylsis or Equivalent w NRCS Estimate, Technical Guide Section 633..
Enter the value received by.qO" col4mn,(10) from (8). Ppopuesub.traGUngcdumn(IO)tom oW" I)fiollowft each irrigation emr&.

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-- ... --- - - .Tract #
Field Size.(wetted acres) _ (A]
Farm Owner
Owner's Address
Owner's Phone #
..-Lagoon14uld-Imgatton Fitj ,:Record
One Fbrm-16r-Each-FWd;per•--6rop Cycle
.3771 '.: .. field #
r 9
4.95
Neil Barwick
340 Dr: Wiilliams Rd.
1(enansville NC 28349
Facility, Number 31 - 99
Irrigation Operator. Neil BW**
Irrigation Operator's 340 Dr-,-WIIHams Rd.
Address Kerlansirilie . TrtC. 28349
Operator's.Phone# 910-29"028
From Waste UNIIZation'Plan ..
Crop Type Reoommended PAN 202
liMliet Loading (Ib/ecr.9 _ (Bj
e21 f31 W 151 (81 M (81 is) [101 f11) .
Date.,::..
(mm/ddkr)_:
IrMH
ion
Waste Analysis
PAN*
Ob/1DDD 9M)
PAN Applied
(IbJecre} -
(8) x (9)
1000
Nitrogen
Baisnce'"
.(19acre)
10) - 00)
Start
Time
End
Time
.7otal=
Minutes .
(3) - (2) -
:.: ttor
Sprifllder8.
Opertrting
flow.
:- Rate
.(gallmin)
Total.Volume
:.r.. (gallons)'
(6) x (5) x (4)
m
Volue
per Acre
(gallacre) .
-.(7) / (A) -
W,05
.. 4:00
' AW
1
198
... 95040
10200-00
2.2
42.24
- ,159.78
480
1,
-:. = 188
. T . 95040
19200. 00
: - 2.2
42.24
. - T 17,52
7111105
'f 3Q
3:30
480
- : 1
= 198
:. 95040
19200-00
:' -2.2
42.24
, 7$:28
711?J05
$.00
: A00
480
:_:, 1
:: ` 198
: '. 95040
19200.00
2.2
42.24
.'33:04
: ::81i91b5
"i:15.'..
3.15
:480
1
::.: °. 1Q8
95040
19200.00
.2.2
42.24:2Q
_..
_
O1C 1 T/91f - • • / Syr
_ ....... .. .. .. - Crop - ��...47,r - �.,
Owner's Signature "f ' Operator's Signature
Certified Operator (Print) Neil Barwick Operator's Certification No. 17370
• NCDA Waste Anayleie or Equivalent or NRCS Estimate, Technical Guide Section 633.
" Enter the value received by. sung, cnlLirnra (10} ficrrl(B). Carltinlre subtracting column .(10): fr+om column (11) follpvrlPg eadrirrigation event.

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3
0
a
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FORM IRR-2
Tract 0
Field Size (wetlid acres) = (A)
Farm Owner
Owner's Address
Owners Phone #
Lagoon- Liauid:lydgabon Fields Record
One -Form for Each Field per Crop Cycle
37-70 - .
. - Field #
1
3.73
Neil Barwick
340. Dr,­WiHiams.Rd: • __
Kenansville .-NC 28349,
910-29B-1028' . .:; - . • -:
:. Faciity Number 311-1 99
In1gehon Operator Neil Barwick
irrigation Operators 340 Dr::Williams: Rd:.
Address Kenansvft, NC28349
Operator's Phone # [phone],
-from Waseie Wize8on Plan
Crop type Reoon�mended PAN 235
,CB .. , Loading (ib/acre) = (B)
rs)- M 161 (6) (7) fa) (91 (1U) rill
Date -_
(mmldd"
rri ton
-
Waste Analysis
:. PAN',
(Wl coo gal)
PAN Applied
(Iblacrs)
($).g (9)
f 000
Nitrogen
Balance"
ghfacrp)
(0) - 00)
Start .
Time
EndTotal
Tlme
Minutes
(3) - (2) ....
of
Sprinklers
Operpdng.;�
-Flow
.. Rate
• - (gallmtn)
Total Volume
•(gallons)
(6) x (5) x (4)
Volrirne
per Acre
,-. tgafdre) ,
. (7)1(A)
B= 235
Bit 0V 5
8:00
1:34
- An
_ ..:...
:...:..... 1.88
. .: 65340
.. 17517.43
. •. ; 2:2
' .. •... 38-54
.. _ ._.... 196-.46
Wfl- 05
' $:00
: 2:30
. - 330
1
:. 19$
65110
17517:43
'. ' ..2.2
U.0
157:92
7I14J05
7:3Q
. 1:00
330
1.
198.
68340
17517:43
2.2
= :313.54
' . 119;38
71151 5
$:04
1:3Q
330
1
:.. 1.98
65940
17517.43
2.2
.38.54
- 80:85
.: 8=06
130
. 1:00
:. -330
65340
17517.43
2.2
30.54
42.31
$J231r55
8:15
i :45
330
1
:: 198
65340
f 7517:43
- 2.2
38.54
3.77
LR[: I Ili - - - .- ... - .. -
srop. C e
Owner's Signature Operators Signature
Certified Operator (Print) Neil Barwick ,Operators Certification No. 17370
NCDA Waste Anaylsis or Equivalent or MRCS Estimate, Technical Guide Section 633.
**Enter the value received by subtyacting column (10) from (8)..Continue subtracting column (10) from column.(11) folkawing each irrigation event,

4
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LL
U
x
FORM !RR-2
Tract #
Field Size (wetted acres) = (Al
Farm Owner
Owners Address
Owners Phone #
LagbbnIiquid -Irrigation flidids Record
.Orie- Form for Each Field per. Crop Cycle
3770 -
Field #
3
5.12
Neil Bai<wick
340Dr.=Williams'Rd. -
Kensnsville NC 28349,1.:
. •. ;w: - 9'
Facilily Number 31 - 99
Irrigation Operator' Neil B61rwick . - . .
Irrigation Operator's 340 De: •WlHiams-Rd:
Addi+ess KenansvHlb •.NC.28349
Operator's Phone [phone]-'1028
FnoM-Wattfe Utillratlon Vien
Crop Ty Recommended PAN 202
Millet Loading (Ibh�cre) _ (B)
(3) 141 im fel 17% (a1 (9) (101
'
Date -
mrn).
= r
ation
WasteAneiysis
; .. PAN" . .
(&1600 gal)
PAN Applied
tlWecre)
011191
1000
Nitrogen
Manes-
. (Iblacre)
M - 00)
Start'.
Time
End
Time.
Total•.
Minutes.
(3) - (2) : '.
dof
Sprinklers
Operating-.
: Flow'
Rafe.
(gaftffi)
-.Total.Volume
(gallons),
(6).x (5).x (4)
volume
per Acre
:.-(gallacre) .
(7) (A). - -
B- 202
- :6J15/05
7:30
.... 3:30
:. 480
1
- 198
.. 95040
18562.50
2.2
:: 40.84
161.18
fi/18J05
7:30
.- .: 3:30
: 480
:• 1
. 188
95040
18562.50
= :-2.2
:: 40.84
120.33
7/20105
8:30
; 1: 4:30
- 480
Jr-198
95040
18W2.50
2.2
40.84
. 79:49
..: 71211Q5
B:QQ
::...4:00
480
1.
188
.: 95040
18562.50
::-,.2.2
40.84
38;65
:;8J2fi/05
8:30
4:30
480
1
., . 198
95040
18 - .50
::: 2.2
40.94
.. -2.19
7.
Crop Cyclle Totais :. 475 .19
Owners SlgnaWre Operators Signatufe
Certified Operator (Print) Neil Barwick OperaiWs Certification No. 17370
` NCDA Waste Anaytsis or Equivalent or MRCS Est}rnate. Technical Wde Section W3. .
'" Enter the value reosived by subtracting ocurnn (10) frorr4 (B). Continue subtracting ealurnn•(10) from ooiumn (11) faibwing poqh irrigation event,.

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Fovea IRR-2
Tract #
Field Size (wetted acres) z (A)
Farm Owner
Owner's Address
Owner's Phone #
Lagoon Liquid Irrigation Fields Record
One Form for Each Field per Crop Cycle
377Q
1 Field #
F 4
5.12
Neil Barwick
340 Dr. Williams Rd.
Kenansville NC 28349
910-298-1028
Facility Number 1 31 - 99
Irrigation Operator Neil Barwick
Irrigation Operator's 340 Dr. Williams Rd.
Address Kenansvil le, NC 28349
Operator's Phone # [phone]
From waste utilization Plan
Crop Type Recommended PAN 202
Millet I Loading (lb/acre) - (6)
(1) (2) (3) (4) 5 (8) ( B) (9) (10) 1 �)
Data
(rnm/ddlyr)
rri ation
Waste Analysis
PAN&
00000 gal)
PAN Applied
(lblecre)
(A) x (M
1000
Nitrogen
Balance*"
pblacre)
(B) - (10)
start
Time
End
Time
Total
Minutes
(3) - (2)
# of
Sprinklers
Operating
Flow
Rate
(galitnin)
Taal Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gallacre)
m l W
B= 202
6/17/05
8:00
4:00
480
1
198
95040
18562.50
2.2
40.84
161.18
6118/05
7:30
3:30
480
1
198
95040
18562.50
2.2
40.84
120.33
7125/05
7:00
3:00
480
1
198
95040
18562.50
2.2
40.84
79.49
7/26105
7:30
3:30
480
1
198
95040
18562.50
2.2
40.84
38.65
8/27/05
8:30
430
480
1
198
950401
18562.50
2.2
40.84
-2.19
DR: 11f98 Crop Cycle Totals[ 475200j
w
Owners Signature Operator's Signature
Certified Operator (Print) Neil Barwick Operator's Certification No. 17370
' NCDA Waste Ansylsis or Equivalent or NRCS Estimate, Technical Guide Section 633.
204.19
" Enter the value received by subtracting column (10) from (9). Continue subtracting column (1Q) fmm column (11) following each irrigation event.

FoRm IRR•2
Tract #
Field Sore (wetted acres).= (A]
Farris Owner
Owners Address
Owner's Phone #
3770 : -Field #
5
5.12
Neil Barwick
340:Dt. Wilriams Rd:
KerlgnsviW NC-28349.
.. ' Lagodii -�Liquid:Imgation :Fields Record
On6form:f&'Each Field'per Crop Cycle
FAcliity:Number F 7 31 - 99
Iri oadon Operator Neil Barwick
Irrigation Operators- 340 :Dr,. Williams Rd... `
Addnass. Kdriansviile, NC 28349
Operator's Phone# 91D496-1028'
From ikMa UtlIkeloif Plan
Crop Type Recommended FAN 202
Millet Loading (Weere) (B)
{t) � :. 0 (31- (4) (61 (a) M ray (9) Mm (11)
Date
(mmlddlyr):
Irrigon
WastAAnalysIs
.. PANT" :.
...ObI11000 gal) .
PAN Applied
°.(IWaore)
ls) X-M
loan
Nitrogen
Balance"
(Iblacre}
iB) - (10)
Start:
Time
::End.:,:
Time :.
TCARh
Minutes
(3) - (2).­
0 of .:
Sprinklers,.-
; ,Operatinq
Flow
:. .Rate
= (gal/min) . _
:.. Total;lfdlume
(galionsp
(6) x (5) x (4) .
Volume
per Aare
(9ava•
- -.(7)( (A)
202
-.6/20/05
8:00
: ::4:00
480
95040
18552.50
2.2
" . =40.84
: 1B1.1B
>,..: 612l105
7:30.
; .: 3:30
:. 480
::=
=: 19s
' _' 950:40
18562.50
. 2.2
: - 40.84
.120.33
. 7127105
9:30
. 5:30
480
1
: > .. 19B
;: 95040
1$562.50
: 2.2
40.84
..: : ` 79.49
-.7128105
8:3Q
. 4'.30
460
4
i8$
.: 95040
1a562.50
2.2
:40.84
-. -: -38.6
W29/05
9: Ey0
: ; 5:8Q
, 480
ti
:' 1.98
95Q4
18562.54
2.2
40.
-2.18
S
rop Cyclip bfAls .:
Owner's Signature Operators Signature
Certified Operator (Print) Neil Barwick Operators CerthIcadon No. 17370_.. •— - —
' NCDA Waste Anaylsis or Equivalent or NRCS Estimate, TechrNc d Guide Sedon 633,
" Enter the value received by euW4dipg column (10) (rpm (B).. Caatinue subhacting: oofumn (10) trpm column {1 t) following eadt.krigatlon even!.
0
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3)
x
z
m
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W
m
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m
cn
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3

m
FORM IRR-2 Lagoon Liquid Irrigation Fields Record
a- One Form for Each Field per Crop Cycle
1i
it
14
r)
m
m
m
a
Z
x
a:
U-
Traci #
Field Size (wetted acres) = (A)
Farm Owner
Owner's Address
Orwneea Phone #
3770 t Fields
F6
5.12
Neil Barwick
340 Dr. Wiiliarns Rd.
Kenansv(lle NC 28349
910-296-1028
Facility Number 311-1 99
Irrigation Operator Neil Barwick
Irrigation Operator's 340 Dr. Williams Rd.
Address Kenensville NC 28349
Operator's Phone ;# 910-296-1028
From Waste Utilization Plan
Crop Type Recommended PAN 202
Millet - Loading (Iblacm) = (B)
0) (2) (3) (4) (5) (s) (7) (a) (9) (10) (11)
pate
(mmlddlyr)
Inigation
Waste Analysis
PAN*
011000 gad
PAN Applied
#blacre)
(Kx (9)
1000
Nitrogen
681ance"
(Iblecre)
M - 00)
Start
Time
End
Time
Total
Minutes
(3) - (2)
g of
Sprinklers
Operating
Flow
Rate
(gallmin)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gailacre)
(7)1(A)
B= 202
6/22/05
7:30
3:30
480
1
198
95M
18562.50
2.2
40.84
161.16
6/23105
8:15
4:151
480
1
198
95040
18562.50
2.2
40.84
120.33
7/30105
8:30
4:30
480
1
198
95040
18562.50
2.2
40.84
79.49
811 /05
7:00
3:00
480
1
198
95040
18562.50
2.2
40.84
38.65
8/30/05
8:00
4:OU
480
1
198
95040
18%2.50
2.2
40.84
-2.19
DR: 11M
Owner's Signature
Certified Operator (Print) Neil Barwick
Crop Cycle Totalsl 476200j
Operator's Signature
Operator's Certification No. 17370
NCDA Waste Aneylsis or Equivalent or NRCS Estimate, Technical Guide Section 633.
1 - 204,191
" Enter the value received by subtracting column (10) from (0). Continue subtracting column (10) from column (11) follovAng each in4ation event.

W
a_
z
LL
FORM IfRR-2
Tract At
Field Size (wetted acres) P (AJ
Farm Owner
Owner's Address
6wm&' s Phone #
Lagoon i=iquid hrigartion Fietda Record
One Farm -for EeckFWd per Crop Cycle
3770- -1
Feld #
2
4.81
Neil BwWck
340 Df.'Williarhs Rd.: .
Kline nsville . NC- 28349
9101298-1028 -- ' : - :
Fecilk Number. 31 - 99
Irrigation Operator Neil Barwick-.
Irrigation Operator's 340 Dr. Williams.Rd. - :
Address.. Kenansville NC 28349
Operator's Phone [phone].
Froon Waste Uti#sation Plan
Crop Type Recommended PAN 235
CB :. Loading (lb/acre} = (B)
(1) (2) (3) (41 (5) (a) m (8) (9) (101 M1)
::.
Date
(mmldd(yr).
:.
Irrigatron
Waste Analysis
PAN"
(lb11000 gal)
PAN Applied
able=)
(81 x (9)
1000
Nitrogen
Belanoe"
:(Ib/acre)
(9) -,00)
Stara
Time'.
= End -
Time
Total. . • .
Minutes
(3) • (2)
.# of
Sprinklers
OperAng.
: Flow:
:Rate
(OaJknin) ..
•Total Volurrhe
.(gallons)
_ . (0).x (5)x (4) -
Vcli me
per Acre
(gavaere)
(7)1(A).
B- 235
- 6/13105
7: 30
3:00
::_ 450
1
1
89 a Q0
18 2 91
::::. 2. 2
40:7
` : '194: 25
6114105
8:00
-:= 3:30
45D
::1
198
80100
t 8523:91
:.. 2:2
40.75
:: � 153.49
• 7/18/05
7:0.0
` :_ 2:30
._ : 450
:._.
89100
18523.91
2.2
40.75
' 112,T4
UP7119/05 0
3:30
450
t . 1
19$
'
-.;= 89100
18523.91'
2.2
= 40:75
= = :.:71.99
8124/05
7: 34
3:00
450
1
,.. 'I
.89 a 00
1$52.3.91
. - ....2'.2
40:75
. 31.24
MUM
8:00
: . _3: 30
_ 450
1
- ;. 198
$9100
18523.91
2.2
- 40:75
::: =9.52
00 CyX Totals 53000
Owner's Signatures, Operator's Signature
Certified Operator (Print) Neil Barwick Operator's Certfication No. 17370 . .
• NCDA Waste Anaylsis or Equivalent or NRCS Estimate, Technical Guide Section 633. .
Eater the value received;py,su6trac Ling oolumn.(10) from (B). Continue subtracting column.(10) (rom.column (11) following each irrigation event.
LL,

(Type of Visit 0Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 7i•' Departure Time: ; �ounty:
Farm Name: s Owner Email:
Owner Name: ,/ U`� �1�'rl� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ 4-95L AU' ZC K
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
❑ o
Latitude:
Region:
Phone No:
Integrator•�dGL S __
Operator Certification Number:
Back-up Certification Number:
0 « Longitude: ❑ o ❑ , ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et . _ --
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Dischar¢es & 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 Heife3
❑ 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?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
12128104 Continued

Facility Number:,,-3—
Date of Inspection
Waste Collection & Treatment r
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struc-turcO S truc uye Struclu� 3 Structure 4 Structure 5 Structure 6
Identifier: 7` fO
Spillway?: /1i0 O NO 14
Designed Freeboard (in): / 2 S
Observed Freeboard (in):1p0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
;dNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
21 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 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
[PNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
/ZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift El Application Outside of ALa
12. Croptype(s) ©r/E/LS6,ED LGG�7
13. Soil e s
tyP ( )
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
71 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA ❑ NE
116. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
o 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
/0No
,L�'No
❑ NA ❑ NE
4VO �e'6 1W5 Z'-Ve %Z
OVO
Reviewer/Inspector Name - Phone: O- --3
Reviewer/Inspector Signature: Date: (�
12/28/04 Continued

_Facility Number: `lj� — �� Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:]Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ;Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I ° Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
P?rNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
7No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
01 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ZfNo
❑ 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
;9No
❑ NA
❑ NE
12128104

Type of Visit MrCompliance Inspection O Operation Review O Lagoon Evaluation,
Reason for Visit Routine Q Complaint 0 Follow up 0 Emergency Notifi aE i�0 Other ❑ Denied Access
Facility Number Date of Visit: Tirtae:
Q No# O erational Q Below Threshold
Permitted)Certified M Conditionally CCeprtaiieed� [3 Registered Date Last Operated or Above Threshold: .............
Farm Name. .......�..Y �.AP.t-6 ... ��`:O........'..PI.9".".... �L...- �... County: �i� ......:................ ...----------
OwnerName: .... .... ......................... ...................................................................................... Phone No:.......................................................................................
MailingAddress: ................. .................................... . ..........
FacilityContact: ........._............ Title:.---••--------- -- - - - - Phone No: W_..W... __ ......... ...... .......................................................
OnsiteRepresentative: ,�EsL �{�.5 - Int ( tor• /�(iRf Z-0L�- S
Certified Operator :............................ ........................................ Operator Certification Number:................................ .-....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & 66 Longitude • 4 64
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 2fNo
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) 0 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)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ... w tr..�?1< �..... J♦. "...�#--
Freeboard (inches): 25 70 2-7
12112103 3 3
�kfl iz 19
❑ Yes ❑ N
❑ Yes J� SV
❑ Yes V
❑ Yes No
Structure 6
Continued

Facility Number: Date of Inspection L
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes /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)
/I,0
7. Do any of the structures need maintenance/improvement?
❑ Yes
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
/
❑ Yes:00
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 maintenanceJimprovement?
❑ Yes��No
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 &R ouDA (Cy ) SG Wee-V-6b 5ut^m6e- 4 (-V9Nv4,5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes OF N
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 7Ng-
c) b) Does the facility need a wettable acre determination? ❑ Yes
This facility is pended for a wettable acre determination? El Yes �N�Qoo,
Zo'
15. Does the receiving crop need improvement? ❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ��N�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.
0&0 wfg wM UP4ATF.9 LOT-6 01i
Lrnn(. ACaDE9 Tr.l z6o':5
❑ Field Copy ❑ Final Notes
Lfl�-oo� 1 _q NRs Qe�d DvhJE .
5wA{,� 5ur2VE� To �C p�E �~1 APR, 2_�
fAW I, i�EC'6(Lcts
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
AL A2 IwJ

Facility Number: 31 Date of Inspection 2,�(
Required Records & Documents
WNO
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
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
E N
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
No
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
L/J
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
O/No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
28_ Does facility require a follow-up visit by same agency?
❑ Yes
N
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)
Pes
❑ N
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
92
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
��Iqo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Division of Water Quality w
: a piv�sion of Soil and Water Canservahon
Q Othei Agency Y }
Type of Visit 10 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of V, 't::/ Time:
472 Not Operational Q Below Threshold
�F,rm
CldCPermitted OCertified © Conditionally Certified 13Registered Date Last Operateor Above Threshold•
Name: 4eLe__ 4Uaj 6&l County:
Owner Name: _ Z/- A RW;2-_ L Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: [ 1?t-JZ CK_
Certified Operator:
Location of Farm:
i
Phone No:
Integrator:
Operator Certification Number:
16 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 K Longitude 0 6 �«
Design Current
awicac t-apaciry r0 ulation
❑ Wean to Feeder
u Farrow to Wean
❑ Farrow to Feeder
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I 1 10 Dairy
❑ Non -Layer I I J[:1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ® ❑ Subsurface Drains Present ❑ l.a oon Area JE1 Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
e. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
/11No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes jLJ No
Waste Collection & Treatment /
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes /No
Strut Structu e� Structure 3 Structure 4 Structure 5 Structure 6//
Identifier:
Freeboard (inches): 29
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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) Cee
7. Do any of the structures need maintenance/improvement? Yes 00No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ YesNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level Y,
elevation markings? ElYes I/J No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes No
11. Is there evidence of over application? ❑ Excessive Ponding [IPAN ElHydraujic Overload ` ElYes �fNo
12. Crop type
13. Do the receiving crops differ with those designated in the C rtified Animal Waste Manage nt Plan (CAWM❑Yes A
No P .
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? El Yes YNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes �No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes / No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes J(� No
24. Does facility require a follow-up visit by same agency? ❑ Yes �No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �ZNO
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy l_I Final Notes
&eA %e-o51 E J T OW�`r>P� .4r _5 7-,E j �1, %17iQ
�f�IQuI�C IS 54z"o 7�A i /� Fi)6: iJ C6k tdZ_7;V (ZZ)Ar4C
5 _ g)0'et_ �fJ �� SLG-� C �7lloF�� to
,�5e�erz_- 7o krxr-,� W4movrx�) F/4/1,v 61koinA,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
05103101
Date:
Continued

Facility Number: 15FT Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 a
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)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes VN0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or f
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 pennanent/temporary cover? ❑ Yes ❑ No
' ©io pirm'05 &JO /�zP,FS 111,gDafJo Go0'45
AV
17) ZL[ Cer 41�
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�/}7t-- �G
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"t-jwllww n c'
O5103101
�AW7 1147ze-c r7_
If

' � 1
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: '�'�^ Time: qt{ -
Q -NutOperational Q Below Threshold
4permitted 13 Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: .... ..4"V ...................................... .......................... County:. �t'i .......... _.....�....
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: ........................ ••..........................•---....---................---............--•------............................................ ...... ........ ...... ............... ...... ............ ... .................. ...
Onsite Representative:.L„J t^! ............. ............. Integrator:.. �..!�'�1�..... ......................... ..
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude • 4 rd
.Design_. Cuii: t .: Design ; Cuirreint Uestgn ; Curi i
-. .
_fry_ Capacity. Population °`.Cattle _Capacity:::Popnlatl
SWme do_Po Mahon Pou!
Wean to Feeder
Feeder to Finish
ptj
Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
Num6erof Lagooas _ ❑ Subsurface Drains Present 1JE3 ❑ S
Lagoon Area pray Field Area
;:Holding Pomds / Solid Traps" ❑ No Liquid Waste Management System r
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
[] Yes ❑ No
c. 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 ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes J9No
Structure StruCtur9 2 Structure 3 Structure 4 Structure 5
Identifier: ............ [.:�s....L D.. I-Ly... r. ........?...:.. �� .........................................................................................................._........
Structure G
Freeboard (inches):
5/00
Continued on back

i I `
Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes PNo
(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? WYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes O'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 14 No
11. Is there evidence of over application? , ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes MNo
12. Crop type by) r <-e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes JXNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
J�RWo
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
D'No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
b 'No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
&No
18.
Does she facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
k(No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
52rNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
O(No
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
Oio
24.
Does facility require a follow-up visit by same agency?
❑ Yes
qNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
0; �-yiolatiQtos'ep defc�epcie5 were potted drrriiig �:his;vis�t! • Y;op w�l•t�eeeiye too furt�g�
Tories deace about this visit`
-:.. .E --
Coif nents (refer: to question ) :Explain any_ YES answers and/or. any recommea da its oc aay outer comments.
Use drawinga'of facihty-to bettetr explain siWationss. (ise addiitional pages as necessary)
a:* -
t9) a L"5 ci�"
�C
I
At--, '�� T�2�dct� J �N. lit-.t�ti vt.3i
%
Q irp- aj4�il
_'77
� 77.
Reviewer/Inspector Name , x
Reviewer/Inspector Signature: Date: S/pp

1Facility Number: — Date of Inspection Q
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ 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 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or I ,
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 V�No
Additioomments andlor Drawings: _
T7) (�p1y� ,�[ �y1(l' /��n� �r �{ I1 �1_.jY/./��/.��__. l{�(��, iy`{- 'E{y\. � [
6.0Pe-f ti
W 1i� i LW—
w
5/00

- 0 Division of Soil and Water Conservation Operation Reyiew y-
�- s --El Division of Soil and Water Conservation,- Compliance inspection _
Orvision of Water ty = Compliance Inspection -
_ , ther Agency _ Opei abQriaho _Revrery
Routine O Complaint Q Follow-up of DWQinspection Q Follow-u of DSWC review Q Other
Facility Number Date of Inspection - /$
Time of Inspection EIZ224 hr. (hh:mm)
© Permitted © Certified Q ConditioAally Certified © Registered 113 Not O erational Date Last Operated:
Farm Name: R ...................�-...t .......................... County:.---.......l ki
1-1-14-
....
OwnerName:. ............................../../................ ....................................................
..-................. Phone No:.......................................................................................
Facility Contact: .........�1 L ........ rf'✓Ij• ......Title:.........-.... `` ........... Phone No:
MailingAddress:.........................................................�,................................-.................. ................................................. .. ..........................
&ill
Onsite Representative ...... ...... l_.!�''r .... w�� . Integrator: ..................... ........................................
Certified Operator: ...................................
Location of Farm;
........ Operator Certification Number: ..........................................
....................................................................................... ........................................`...................................... -...-....................................-....................................................
w
...............................................................•----...-.....-.-........-. .
.t
Latitude 0 9 •1 Longitude 0 ° 64
Design Current." ­Design _ Design Current ..,.Current
Poultry =Ca acit Po ulatio
.Swine - Capacity Po ulation p y .. p n . ,Cattle Capacity Population '
❑ Wean to Feeder
Feeder to Finish
3 QD
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons . ❑ Subsurface Drains Present ❑Lagoon Area 1E1 Spray Field Area
~Hold>ng-Ponds /Solid Traps ❑ No Liquid Waste Management System
v . d := -; .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P(No
Discharge originated at: [ILagoon ❑ 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. Docs discharge bypass a lagoon systern? (Ir 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
Str cture I Structure 2 Structure 3 Structure 4 Structure 5
Ho
Identifier: 1r ) , JAVK&,e
Freeboard (inches): 3Ito n.!Ill�i-.......... 3.}..u..
5. Are there any immediate threats to the integri of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
%,No
❑ Yes
o
❑ Yes
No
Structure 6
❑ Yes KNO
Continued on back
3/23/99

Facility Number: ?� — Date of inspection
(� J
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
o
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
ElYes
tNo
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
RN
11 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
7No
12. Crop type -GAr rf C S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ Yes
fij�No
c) This facility is pended for a wettable acre determination?
❑ Yes
P'No
15. Does the receiving crop need improvement?
❑ Yes
XTo
16. Is there a lack of adequate waste application equipment?
❑ Yes
&(No
Renuired Records & Document%
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
gNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) 1
❑ Yes
14No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
% No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P<NO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JVNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
VNNo
23.
Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
❑ Yes
KNO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
VTo
25_
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Wo
viola[ions. . . .. ert. . . v�ere itgted d>�ri°iitg tbis:visit: - Y;oit wiil-teeeiye iid further • : _
�arresPoridence. albaut� this .visit" ........ . . . .
Comments:'(refer to gaest,on #) :Explain any'YES answers and/ or.any`recommendations onany other comtnents
w.,�. _ s
Use drawtngs"of faciLty to betterexpla,n situahons (use:add�tioital' pages asnecessary) r 1 N r
_ .. . . d 7. _ _ y
1ua5v,�
ea on a cAyle W -A, loii-l- �• �ak��
Reviewer/Inspector Name
Reviewer/Inspector Signature: [i ,,,, IJ :arc. Date: 1d

r
Facility Number: — Date of Inspection
Odor Is e5
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes " o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N0
28. Is there any evidence of wind drift during land application? (i_e, residue on neighboring vegetation, asphalt, ❑ Yes 0
roads, building structure, and/or public property) 1
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or�No
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 gush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yeso
Xdditionall Comments, an or rarvings-
a
►v -e--k , ylll,�r . Ba,,, jt--c 'S we 4�,L aCrtkV,
ravW� 10-5
r�
Coat Cee l I 1
3/23/99

p_p;m
�O
13 Division of Soil and Water Conservati(ixi:- Operation:Review. A
13 Division of Soil apd.Ilwaiiir:elonser,yationi"�� C6mpliance-Inspection
Division of Water OdMity.- &o ce-IfispectionJ .
jX1
Other Agency - Operation Review
14D Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Date of inspection
Facility Number
Time of Inspection U �20 24 hr. (hh:mm)
Permitted [3 Certified (3 P Conditionally Certified 0 Registered 1[3 Not Operational I Date Last Operated: .......... * ............... Farm Name: ............. &A� ..... ..V .................. County: ......... . ................................... ....................... ....... 1. .r . ....... ... ( ...................... .......... -1-
Owner Name: ............J.k?% . .................. KW ................................ Phone No: .... J.........................................
FacilityContact: .............................................................................. Title: ................... ............................................ Phone No: ...................................................
Mailing Address:.... iL.0 ...... ......... t4c....................................... ............ tj I
... P: ........................... ....
Onsite Representative: ........... N .1 .......... . .................................................. Integrator: C'i'Lra.16 ......................................................
Certified Operator:.......................................................... . .................................................... Operator Certification Number:
Location of Farm-
aU ..... nacAk....
r............................................................................................... . ............................................................................. --* ...............
Latitude Longitude
Design Current Design Cur Design Current
at.
-:Siivine - Cattle' Capacity Population .-Poultry 77 7 Capacity PopulationCapacity Population
E] Wean to Feeder E] Layer El Dairy
Weeder to Finish ❑ Non -Layer F] Non -Dairy
Farrow to Wean - --------
0
Farrow to Feeder '10 Other
❑ Farrow to Finish
Total Desikfi° Capacity
E] Gilts, 4W
Total S L El Boars
=Subsurface Drains I[] Lagoon Area I0 Spray Field Area
Number of-Lagoo'ns Present
Holding Ponds,/ Solid Traps =No Liquid Waste Management System
DischaMes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes NO
Discharge originated at: El Lagoon [] Spray Field [] Other
a, If discharge is observed, was the conveyance man-made'! El Yes [0 No
b. if discharge is observed, did it reach Water of the State? (Ir yes, notify DWQ)' E] Yes P No
c. If discharge is observed, what is the estimated flow in -allmin?
0
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? D Spillway
Structure I StrucTe 2 Structure 3 Structure 4 Structure 5
Identifier: 1-4 U� t LQ1a
Freeboard(inches): .......... -30 ............... ............. ............... I ........ ...................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
[] Yes P No
El Yes [P No
[j Yes Efl No
[] Yes PNo
Structure 6
El Yes P No
Continued on back
3123/99

Facility Number: 3i — Date of Inspection t
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 40 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Yes ❑ No
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
!
12. Croptype �YYnoa nay _ �r,���1 r�-cr,�.on�,�. t,Js►�ttir..{,tiy1Y►4�1*` s�}vu.rr►�r 1aL+„
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
OYes
❑ No
15. Docs the receiving crop need improvement?
❑ Yes
n No
Lp
16. Is there a lack of adequate waste application equipment?
❑ Yes
EjNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[�)No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Wo
l9.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONo
20.
'Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[BNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
F4No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
�No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RNo
:.
�'�io yiofaiioris_o'r deficiencies were noted• dikrtng �his:visit.' • Yoek Will-f&OW fio f'ui•thi-
corres ondence. abio , f this visit . .............. ............... .
Comments (refei•'fo question #)=Explaiin auy-YES answers and!©r`as y t ecommendations: or any,oEher comments:
Use,.drawin s of facility_to better explam situations (use addttiiinal pages.as necessary) v
la
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q. L aar<z SeYv;
God n,
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DU'Ittr r. O kLt. cjkS
at-
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Lwer- �c�-,koulj tX&Ve , t,'L-�-�"+�} lrJ
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lb l c,4`u t v,- C(A Par
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�_ I Lt j i
arVj 'Ili rr-wied,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Al Date: f (Al -All
3123/99

i
Facility Number: -3'— Ill, Date of Inspection Q4�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below rOYes ❑ 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 �10
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El 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 PNo
X 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? Oyes II❑ No
3/23/99

Division of Soil and Water Conservation [3 Other Agency
® Division of Water Quality
L
Routine O Complaint O Follow-u ' of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 3 R Date of Inspection
_j Time of Inspection I'i` I '24 hr. (hh:mm)
13 Registered IN Certified [3 Applied for Permit' 21 Permitted JE3 Not Operational Date Last Operated: .................
Farm Name: ...........Mt,.�L Rvk............ F...rzxf...................................... County: .... �tp��.t~......................................... .......................
Owner Name:............!v'.......&Y..wa ............. ... .. Phone No:.9.a.� L.~1.d.,$' .......
..............................................................................................
Facility Contact:... ..................... ............ .. Title:.................... ........ Phone No:
Mailing Address W ... ......
Re Onstte • presentative: ...... N.61.L..... ........................................................... Integrator:.... �t�.��.5......-----....................................-----........
Certified Operator; ..................... `
.4!' .,..tom+.:.... q�Y...k1(..1..d���........... Operator Certification Number,A.J.�% .........,-
Location of Farm:
.5-.. go............................................................ .f....a..:....`:R....13�ti.ti.....:.`.�...>xtyiA:.i.....11str.�..._.......5 t.....................................................
..... .. ........... .. ................... _.... .-- .... .. ............... ...
Latitude ©•,�� Oo '� Longitude
General
L Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what'is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 19 No
❑ Yes ® No
❑ Yes M No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
Continued on back

J
i
! Fact}tty Number: -si — g
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (La2oonQjIoldina Ponds Flush Pits etr'.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 00 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 0
Identifier: r 4
Freeboard (ft):.............. .:i.............. ........ 1'`1
10. Is seepage observed from any of the structures'? ❑ Yes ® No
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)
S
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste application
14. Is there physical evidence of over application'? ❑ Yes f5d No
(If in excess of WMP, or runoff entering waters of the State, notil-v DWQ) I_
...........atl Y,►.�.�.............. ....a�tCA vk.............. 5!! . ^m:...i�sn.tl9�.l................................. ..-..................
L 5. Crop type ................ !Y!!u............. �j4cy....;
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWM11)? ❑ Yes [M No
ti -
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes IV No
18. Does the receiving crop need improvement? Yes ❑ No
r
19. Is there a lack of available waste application equipment? ❑ Yes %No
20, Does facility require -a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes No
22. Does record keeping need improvement? ( Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes 91 No
24. Were any additional problems noted which cause noncompliance'of the Certified AWMP? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes W No
[] No violations or deficiencies. were' note'd-during this, visit. You mill receive no further
correspondence about this.visif.
Comments-.(iefer'to question#): Explain any YES answers and/or any recomrrseisdatsons-or any`other comments ,:
'
Use drawings offacility to'better explain situations, ('use additional pages as necessary)
12. A-0 KSeet} 60"C. cocas o J, "M 4hre j a��►s. i nLt i a acl!,
sJWQ LxW.-j 4f,, dtJ w,-e- t,ckWW t.se,eded, Wee 56)0 w•ociej of
�1 �'^"t Sv�►^al •t^ c�i'hgS Cadcjr.
j
n
kg,�o
Sat t� wa5it Sl1ot� lse. VPc�a.
`S
eWAA, '
yL41�UlU 1�2 A, ' l t&G Ct T �Jt CfD11�A�Wi9o� r� �AUi�k- COY G, LAa��
�l y
x soz
7/25197
ReviewerlInspector Name
Reviewer/Inspector Signature: ` Date:

❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Q Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection i t S 4-
Facility Number OL
Time of Inspection LZ : 24 hr. (hh:mm)
13 Registered MCertified © Applied for Permit E3 Permitted 113 Not O crationa) Date Last Operated: ..........................
Farm Name:.. .... ,A. to ......�County:.... .......
Owner Name y ... arr:se►d. l...tAL................................ Phone No: �i. (..A .. z .4...`. i �. Z 8 ....
Facility Contact: ............................................................... Title: Phone No:
Mailing Address: ... 3. .. ....... ?.r...r................ S..V...!... �....N.�.--.---- ..4:93.` 1
Onsite Representative:....N.C.-L .{.l`r iat.,.L. .......................................... Integrator:.....t tsr.+c:r�z..�. r..................
Certified Operator:—FK'dv'G k........9LLY..t 'r'. k......................................... Operator Certification Number...... ...........
Location of Farm.
:: p �4„i..►!3r q,,.. 1.....rra.,.� ..... 5.:.�.1.... $....... ix,
........ ....
Latitude �•' �'� Longitude*
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gifts
❑ Boars
Design; : Curirent:
❑ Dais
❑ Non
De`s�gnCapf
(General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 29 No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7- Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes ErNo
❑ Yes
CKNo
❑ Yes
JRNo
❑ Yes
KNo
❑ Yes
W No
❑ Yes
12!�No
❑ Yes
RNo
❑ Yes
® No
❑ Yes
KNo
Continued
on back

1F aeility Number: ` ) —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeo.ons.tloldine Ponds, Flush Pits, etc.
❑ Yes 99 No
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes R No
Lots) LNt,,)
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z._:..]............. ........... 3_1..........
Freeboard (ft): ...--.......... .......•.............•.........
10- is seepage observed from any of the structures? ❑ Yes CR No
11. Is erosion, or any other threats to the integrity of any of the structures observed? 2LYes ❑ No
12. Do any of the structures need maintenance/improvement?, jg 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 No
NVaste Application
14. Is there physical evidence of over application? ❑ Yes 09-No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .Sr±cs�,r..-..,r....... x�...}.era..+....................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes WNo
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25, Were any additional problems noted which cause noncompliance of the Permit?
0 No.vioIa'dons-o'r ddidencies.wereno'ted-during this.visit.- No_ u.wiH receive -
no furt�ie_r
:.•cbrrespondeinceab"outthis:visit:-: .. ;: .�•:� �::.:: .-�.•;.,:,. � :�.- :. , .•
❑ Yes tgNo
❑ Yes RNo
❑ Yes 99'No
❑ Yes RNo
❑ Yes No
,® Yes ❑ No
❑ Yes IqNo
❑ Yes Eff No
❑ Yes KNo
'?» -. < .F2.�. -
Comments (refer to quTestion #} &Explarn any YES answers andlor ainy remumindatlons or any other comment MMM"
z s � � . �` � • � � r� �.�,�� � �-
Use drawings of fablity to better explain srtuahons (use add t�tonal pages as necessary)
ff _. .
L a t c t _A D o K_c
11. 1Z • 5 l i k i- �Q.-rp 1 'It � w a-3 o L �-�o( � t-�� o i�,t- �•v c- i S �q
k-e 1 t
c v L..L 1& c- 0 r-�-R c f-�C. %,— D -d-at -14 0 I-1 a L 1 �, a -e 1-�e..� o
L v v. W w.1 I s Q S c i a L d. 1 a {� K
�'�a.. • a-c, Q P � p-:3- � } �Y.-0 tJ� �t. h@.[I-'�q '�-rL� . Fi,.+`a l,�
1^-0 LfL +KV. o �1 f t'�. [3r-
;J.ti im
ct,,, d a o V L.¢ z-S
�-Q1, +4 L O , C [I �' v—�9 tv�`ol. C-r 1 v+ p-r► .... +^.�¢.✓ µ7cL t Q �t�-� O itk
v
�•[ �..� • V
s�
�.�.
I. D L-) Q
L y •�-i �-a c c,'-
CG..i0.L� pl1S+L` 4t'f'J i Sp2.Ci GQ{����
V��r 1 �-1 C 0.. ['[ � "�^- �T L _' � I � �-q C 0 t/l � 0✓rti �+^-IL C�-�^�`-C V Y4 L �
W cs a ct-.� C R i 1.. 1 e # a
7/25/97
[1 ' r .S o ar os r 1 c o.f t .! 3 d [�-� .
�
Reviewer/Inspector Name
,�
Reviewer/Inspector Signature: x1. Date: it

•
r Site Requires Immediate Attention:_
Facility No.
- DW ISION OF ENVIRONMENTAL MANAGEMENT
ANTMAL FEEDLOT OPERATIONS STTE.VISITATION RECORD
DATE: - �I , 1995
Farm Na
Mailing.
County:
Integrate
On Site
Physical Address/Location:
i Time:
- c
1
-!+J
T 1 llVlll.. (�
Type of Operation: Swine ✓ Poultry ' Cattle
Design Capacity: a S _,)-0 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: tiLongitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot f 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard- Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? es or No Is the cover crop adequate?Aor No
Crop(s) being utilized: c CO- — O {tz b
Does the facility meet SCS minimum setback criteria?. 200 F et from Dwellings? Yes or No'
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-made devices? Yes or No 7 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 -vkc,*-JbLJ
Additional Comments: _:a A 14) l rt.<�cu.t a— off,. —fir- WOO
_ - I , n 1 _// 11 _ `, " /it
°`Q.0
Inspector Name SignatuiQ
Cat.PAID,
ce: Facility Assessment Unit ;:.: Use Attachments if Needed.