310102_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Facility -Number; - f Q Z O Div>sion afSoil a4d°Watei^ ConservahoILL'
•_
Type of Visit: Com ' nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: URoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: 20 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: " ' - t C u -C [ i Qfli
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
:w, �'
pi Deli Current ' =1]es n Current`°
Desig4 Current �'-
a
r
Swme „
x �
. Capacity ':Pop WethPgeiltry ,Capar�tyPopGattle Cap city ;Pop
; m'
Layer DairyCow
Non La er DairyCalf
".
w s , :: DairyHeifer
;, DesignCurrent. D Cow
v :
. D. P.oal,Ca aci P,n Non -Da'
,,4
La ers Beef Stocker
Non -Layers Beef Feeder
e
a Pullets Beef Brood Cow
Zt
Turkeys
'
Other..
Turke Poults
Other
Other
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
I+Io
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
[] NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
*o
❑ 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 I of 3 2/4/20I5 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3 11° ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ( �_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-1 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IQ LV o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ONo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, 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 ENo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2"�o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes [� No
❑ Yes �No
❑ YesF]"No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ WUP [3 Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [E�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fj No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili dumber: 31 - (J' 'Z jDate of Inspection: 5
A
/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
D Yes
❑ No
E2r 1�❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
3C> -� (tLo,, C 5 L 4. t fD�r/eW
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes Ea -No ❑ NA ❑ NE
❑ Yes [P,<o ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes No
❑ Yes [�No
❑ YesCl"No
❑ Yes EY<o
[] NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Phone: / ' 7-�a
Date: �/ / 7
21412015

Division of Water Quality
'Fatality Number - © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 01compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ,01outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y Arrival Time: & (V�Departure Time: ounty: I Jc.,&kL Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title: Phone:
Ach.Nek Vows
Integrator: M / /j
Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
.Other
Other
Design Current
Capacity Pop.
Discharees and Stream Impacts
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
LNV1L-1.
Pullets
Poults
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
Q-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
rTNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
ENo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
Q'No
❑ NA
❑ NE
2. Is there.evidence of a past discharge from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
j!j No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: 7 - InDate of inspection: L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,[�f No
a. If yes, is waste level into the structural freeboard? ❑ Yes ,INo
Structure 1 Structure 2
Identifier: -2—
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): -.b 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P—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 KNo
❑ 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 Z' No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ,Mo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes P'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E) No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 2) No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes , E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes LE�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes .0' No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ja-No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ,e-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [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 ,e-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes -Eallo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: .
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 2r-No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes Er No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes allo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes )allo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ,�] No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �" o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes P!fNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Z No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes JZNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional Rages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: y �JAS
Date: G 3 0
4/ ,011

iivision of Water Quality
Facility Number O Division of Soil and Water Conservation-'
C1 Other,Agency
Type of Visit Compliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit �outine 0 Complaint 0 follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ounty: Region:
i
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: OrL _/00Z
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
I❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certi nation Number:
Back-up Certification Number:
Latitude: = c = , ='. Longitude: = o = g =
is
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry`
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurke Points
❑ 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
..,.>_4
Numberyof Structures 4
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 P41c,
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
dNo
❑ Yes �No ❑ NA ❑ NE
El Yes VNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[ No
T
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes CA No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2f No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t[_t No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
[] NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
/2
�TNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Vj No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
oNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
O 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 Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E�No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: - ('j X;17 Date of Ins ectiow %
24. Did the facility fail to calibrate waste application equipment as required by the pe t? ❑Yes Ej No ❑ NA ❑ NE
25.1 the facility out of compliance with permit conditions related to sludge? If yes, check ZfYes ❑ No C] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 5fFailure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Otherlssues
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.
34. 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?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �0 No ❑ NA ❑ NE
❑ Yes WTNo ❑ NA ❑ NE
❑ Yes J�j No ❑ NA ❑ NE
❑ Yes .L_I No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes 25 No ❑ NA ❑ NE
❑ Yes
1z No
❑ Yes
No
[:]Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other eomiments`-. «,
Use drawings of facility to better explain situations (use additional pages as necessary).
GdJ(� ko�
Reviewer/Inspector Name:
Phone: V/I/
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit xRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: .Z l(a Arrival Time: 7f��OG Departure Time: County:
Farm Name: G ` Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: / / Title: Phone No:
Onsite Representative: /f/,�s_ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ 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:
Region: Z-`"j
Latitude: = o = 6 = Longitude: [� ° = 4 = «
Design" Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
I)ry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
TA
"Design Current ,:-
Capacity 'Population"-,
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer '
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3" Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes gNo ❑ NA ❑ NE
❑ Yes �;Ko ❑ NA o ❑ N.E
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ,�No ❑ NA El NE
El Yes rJ No ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 31 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ONo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes
Plo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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
E] No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
Z No El ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
T-
9. Does any part of the waste management system other than the waste structures require ❑ Yes
�No El 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 i0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
PTNo ❑ NA ❑ NE
VNo ❑ NA ❑ NE
I No ❑ NA ❑ NE
VNo ❑ NA ❑ NE
VNo ❑ NA ❑ NE
:Commenfs (refer to question: #): Explainany YES answers and/or any` recommendations or anv other comments ` ,.
Ilse drarviirigs of facility to,better explain situations (ose=additional pages as necessary):i
ReviewerllnsP ector Name,
Phone:
Reviewer/Inspector Signature:
Date: �..
Page 2 of 3 12128104 ' Continued

Facility Number: 7—;07Z Date of Inspection
RepLired Records & _Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7No ❑ 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 El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ,Z-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes JZ'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes JMo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Eno
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �io
❑ 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 )21%io
❑ 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
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
JVNo
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
,�+
❑ Yes 1C1 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes P ` ""
❑ NA
❑ NE
Additional Comments and/or Drawings: s
�f'/[/
Page 3 of 3 12128104

Facility Number /Q Z
Type of Visit .-eCompliance Inspection
Reason for Visit.0`Routine 0 Complaint
Date of Visit:
Farm Name:
Time:
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Departure Time: County: Region:
Ar
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: %G Integrator:
Certified Operator: Operator Certification 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
Latitude: = o
Back-up Certification Number:
0 Longitude: = o =' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
L❑ Non-Layet-
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
N❑ Turke Poults
Other. - --- - — -..
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Fieid ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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?
❑ YesZ No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
ZrNo
❑ NA
❑ NE
12128104 Continued

Facility Number: _ Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �Vo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YeS CINo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ;:*o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 12-No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes J2'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 El"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [JNo ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes E,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YeslNo
❑ NA
❑ NE
I S. Does the receiving crop and/or land application site need improvement?
❑ Yes,4Ll`INo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes -[fNNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,E No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes 12 1V o
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ar eAO CW
Reviewer/Inspector Name Phone: -���
Reviewer/Inspector Signature: Date: I G
12128104 Condnued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EI'No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes PNo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes,.J;TNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
'pNo
❑ Yes Po
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes .Q No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes Z No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes j2vo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes Flo
❑ 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 �Z—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
❑ YesVo
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ONo
❑ NA
❑ NE
12128104

Facility Number
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit ozompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit,.()Aoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: _E Departure Time: County: Dir441= RegioA
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative: _�Grr.�f
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Phone:
Phone No:
Integrator• �Z / 1
Operator Certification Number:
Back-up Certification Number:
Latitude: = c =' = Longitude: = ° =' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er I
❑ Non -La er
Other
❑ Other_
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream amoacts
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 Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
❑No
[I NA
El NE
El Yes
El No
❑NA
❑NE
12128104 Continued

FacjlityNumber:', — 62— Date of Inspection G
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
Stryc/ture I S r Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ! �'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): o2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any 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 ❑ 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 Window []Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date: 1 Q
Page 2 of 12/2RI04 Continued

Facility Number: -3! Date of Inspection_/QLv#
Required Records & Documents �T
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ 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
❑ No
❑ 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
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31, Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additi nal Comments and/or Drawings:
zA
Nd fy1n,0"5 //7 e�;Wg
ovx 1 ook1) 'OOCA
c.oy k i efr' y
Fri
Page 3 of 3 12128104

Fact�ity'Number
J
Q�
�f Dtvtsion of Water Qnaht3
0,Divisian of Soil and Water Conservation
0 Other Agency.
Type of Visit ; f Compliance Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visit J6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency
Date of Visit: I�r- _ 1 Arrival Time: Departure Time: County:
Farm Name: i zn �' Owner Email:
Owner Name: /; � _ M ��_/ r .& S Phone:
Mailing Address:
Physical Address:
0 Technical Assistance
0 Other ❑ Denied Access
Region: 441. zC!
Facility Contact: Title: Phone No: ff���
Onsite Representative: L �LTD�J Integrator: _ Ais 4 4e64/ — &'PUZAt
Certified Operator: Operator Certification 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
Back-up Certification Number:
Latitude: = c= i Longitude: 0° 0 i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Other
❑ Other- _ -�
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3— 07i Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. U0^J
Spillway?: Aly
Designed Freeboard (in):
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes '0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes �No
El NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes 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?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes JZ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop W' dow ❑ Evidence of Wind Drift ❑ Application Outsides of Area
12. Crop type(s)
13. Soil type(s) A&A 6A P..4- - - ------ — — —
- -
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes /_1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
VrNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CZrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
IF) GFiov-q r _ZV Ado au &Q
Reviiewer/InspectorName Phone:�j/0
Reviewer/Inspector Signature: Date: 2kkhp
S
12128104 Continued

I w
Facility Number: —} Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes oNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�No El NA ❑ NE
the appropirate box. ❑ �p El Checklists Design ❑Maps El
Checklists / 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
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
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
9NE
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
VrNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�dNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
YJ No
❑ NA
❑ NE
Additsooal Coaments:and/or DTawin s
RFPDar SffOW /J ,�[� L�3 Nf fOzi�G lr Ta
�D� �PD�-Tl G/}G-�o�LL�i��Z(�N rit/2-7ff /��COQAS � �rfOI.J�Ti2G1L'Yali2A-L
�y� �y�ir JTOfli►t ��/,EN? �Qu���A GfvEGS,
12/28/04

t _
z Division of Water ty� a
War
x
Q I?rvrsroa of Sod and
Conservation m
f. /�x��,
srFli/Ller Ae y4
Type of Visit 91Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Not ification O Other ❑ Denied Access
Facility Number Date of Visits S 5 o Time: i S S •�
Q Not Operational Q Below Threshold
'Permitted JWCertified [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: __. $t C. ..... ....._».» .» _ »»»».»»»». »». »» .»». County: ..QWe
Owner Name: Phone No:
\+failing Address:.....
Facility Contact: ........... __. . ».» ... ....»». »..» » Title:..»». ».».». ». Phone No:
Onsite Representative: ...... (V.I. (A.� f ,L..... D4 � ...........,,,».. Integrator:...,,...,,,,....
Certified Operator:.» »..».».»..»....»...._.»....» .. _. _w .».». »_ ..___»._... _... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle [:]Horse Latitude a t " Longitude • 4 «
3
Design Current s Design Ciurent Design " Currents
acr ;;Population ..-Porsltry �� Ca_ ci 4Po "nation ��Cattle Ca acr Po tion.
rFarrow
to Feeder ❑ Layer Dairy
-r to Finish ( p T' Non -Layer _- ❑ Non-Dairy:.2
to Wean
w to FeederOtherw to Finish
x
Total Design Caparaly '
Gilts � ''•° w.
Oar f
Boars ik b r r ,
i.
_ a
r
1 Ss
T
�Nuuiber of LagooEl=
ns
yN..iM — ss;•. ., "fir 3
�.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes �N,/
No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yeso
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [I Spillway ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... . ..• ••-•-..__...._ »................
...»....»_....»»...... ...........»........
Freeboard (inches): 2-1
12/l2103 Continued

FacHity'Number: 31— Date of Inspection v
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)
7. Do any of the structures need maintenance/improvement? ❑ Yes 7No
8. Does any part of the waste management system other than waste structures require maintenan�mprovement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 91Vo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 01Vo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes L d
[]Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type c"AUVA G SGO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes I o
b) Does the facility need a wettable acre determination? ❑ Yes 10
c) This facility is pended for a wettable acre determination? ❑ Yes 64o';
15. Does the receiving crop need improvement? ❑ Yes 10
16. Is there a lack of adequate waste application equipment? ❑ Yes o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes INO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 6410
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 No
Air Quality representative immediately.
-Comments (refer to queshori #} Explara any YES are;tveis and/or any reccrieniiati�ns'or'any ot6encoaents y
Use drawuigs of facility to better eXplarn situations. {�e�additianal pages as necessary) � ❑Field Cop ❑Final Notes
F&ScuL� rM6-Cp LJMLL- (3f FESCEDCD SGF4, Za0q
- 3
Reviewer/Insp ector Name s3 =ter
Reviewer/Inspector Signature: Date: a
12112103 1 1 Continued

Facility Number. Date of inspection S
Required Records & Document~
/
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
E]�No
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
ZO
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
/No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
QNa
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
/
Oe/ discharge, freeboard problems, over application)
❑
QNo
RTo
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
2<C
29. Were any additional problems noted which cause noncompliance of the Certified AWN??
❑ Yes
To
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t-7/o
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes 04 Wc�
33. Did the facility fail to conduct an annual sludge survey? [:]Yes
34. Did the facility fail to calibrate waste application equipment? ❑ Yes
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 10
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

t llliu YY }1lCl. l:UllJCI Y31 LlUL �-
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visir.4skoutine 0 Complaint FOI?M u'p 0 Emergency Notification 0 Other ❑ Denied Access
LFacility Number Date of Visit:
Permitted OCiertified [3 conditional] C Tied 0 Registered
Farm Name: l
Owner Name:L�
Mailing Address:
Date Last Operated o Above Thre1sbold:
County:
Phone No:
Facility Contact: %Title- Phone No:
Onsite Representative: %C!{� / Y��S Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
[swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �' �K Longitude 0 G u
Design Current
swine Us acity ro ulation
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
Gilts
Design Current Design Current
Poultry Capacitv Population Cattle Capacity Population
❑ Layer FI Da❑ Non -Layer 1 Non -Dairy
❑ Other I I I'
Total Design Capacity
Total SSLW
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued
ix�

Facility Number: — Date of Inspection '--`5�-'—Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11, Is there evidence of over application. ❑ Exces)ive Pondi ❑PAN ❑ aulic Overloa
❑Yes
ElNo
12. Crop type L% 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
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16.
is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ 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
'WNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
..g. ., _., - Y'• .; °� --' �. J
Cominents'.(refer to question #). Egplain any YE5 answers.and/or any recommendations or)inyfother comments
Use;drawings of facrlity t better explain situations: (use addtteonal pages, necessary) ;:. 4t
w Field Copy ❑ Final Notes
d
r` OGc-orv[�p ONF E.0111WS6
� G� �/� 7�Di✓ i¢,J /9N� 441%
���'I�
�91-c1 �i'fE /`I�1r ✓�- d u s Wllj -S �i� %fh►-7
ltji0 �� �}� /r7G`'
/�jtlp �L�C'A720� 1���✓pDry ��2 %��� y�9-
�ir�t� �95 02
Reviewer/Inspector Name
a
Reviewer/Inspector Signature:
Date:
05103101 Continued

Facility Number: 3 J —IP2 Date of Inspection T�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional. Comments,and/6r Drawings: U :' _ z- F . .,._ i_ e.. �3A' .
LPG A' �-r1
nu
7,9
O5163101

J ft
.Drvrston of Water Quality
i ' Q Dtvtsegnyof Soil and,Water Conservation
-�<
: Other A ency x a
x ;' • : k
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
©Permitted O Ce 'Tied [3 Conditional] Certified ©Registered
Farm Name:�
Owner Name: ,Q,o�Y %mS
Mailing Address:
Facility Contact: �lTitle:
Onsite Representative:
Certified Operator:
Location of Farm:
Time:
Date Last Operated bove Threshold: _
County: �G
Phone No:
�Phone
/No:
� �
Integrator: T / li►Q�'!I T
Operator Certification Number:
[swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 0 & 0 " Longitude 0 a 0 G 0
Design Current
Design Current Design Current
Swine Capacity Population
Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
❑ Layer ❑ Dairy
Feeder to Finish
❑ Non -Layer I I ILI Non -Da'
Farrow to Wean
❑ Farrow to Feeder
- - - - - -
❑ Other
❑ Farrow to Finish
❑ Gilts
Total Design Capacity
❑ Boars
Total SSLW
Number of Lagoons
10
Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
... ---..... .... -- ---- --
No Liquid Waste Management System j
Holding Ponds 1 Solid Traps
10
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes PfNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes X-T,
No
ElYes No
❑ Yes XNo
Structure 6
Continued

Facility Number:3 — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
[] Yes
XNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Yes
No
immediate public health or environmental threat, notify DWQ)
T Do any of the structures need maintenance/improvement?
❑ Yes
VfNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
El Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Execs 've Pondin ❑ PAN ❑ Hydrau ' verloadc
14
Yes
XNO
l2. Crop type F Z ✓ (+0 v ��'
f
13. Do the receiving crops differ with those designated in tReltertified Animal Waste M nagement Plan (CAWMP)?
YesfNOO
14. a) Does the facility lack adequate acreage for land application?
❑ Yeso
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
❑No
15. Does the receiving crop need improvement?
ClYes
ANO
16. Is there a lack of adequate waste application equipment?
❑ Yes
jYNO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
PI(N o
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
ONo
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
/VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
VNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
eNo
24. Does facility require a follow-up visit by same agency?
0Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
V(No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments:(refer to.questignk f xplatri any VES;ans*6 and/or any�recommendahons or aay of er_-commenfs.
Use drawings of facility to -better explain situations: (use pages as necessary) '� Field Copy El Final Notes ;.,
ik.addi1­4tional
-14
AW
�jN �T /%��TCfi ��/}7 �5 C.�iPZTy�� �l✓ �%erPFiIJ� ��4�
Reviewer/InspectorName
Reviewer/Inspector Signature: Date: Z r*2
05103101 Continued

i]
Facility Number: Q Date of Inspection
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
"e;v
11q) A5
❑ Yes ❑ No
❑ Yes X'Y
o
El Yes 1CJ No
❑ Yes [/No
❑ Yes o
ElYesfNo
o
El Yes
Li/��✓�OcdS �il/�s U�QZ?7�/�. /PEP.2�Sf�7fi7z�/_r
Pw 12W,�Ga✓ftTy�� ��GE, ��c L
- 4blA,l Alp
,, ,
L) -tt- -
��lf ; �v��7tf2o% �� ��✓ .4�E�
05103101

f Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation I
(Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 102 Date of Visit: b/28/200I Time: 15:00 Printed on: 7/3/2001
Not O erational 0 Below Threshold
® Permitted M Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name:lbstic.lftrm......................... ..... County: Auplia................................ .... MR()
Owner Name: Mumhy.FajWjy-F.&rmn .___.------ Phone No, 9aQ289.-1-ji3-(MF-of Ctc�Z-----•-------.1
MailingAddress:QX.:759............................................................................................ Qw..1 i11..SIC........................................................ 284U..............
Facility Contact: ...........................................................Title:.................. Phone No:
Onsite Representative: .I9h4�Jx1C----------------.------_------- -_---- Integrator:
Certified Operator:Alt.ant...................................... Mo.bley ............................................. Operator Certification Number; ZS.ZS9............. ....... .....
_
Location of Farm:
East of Kenansville. On North side (left) of SR 1959 approx. 1.7 miles East of Hwy 11/Hwy 903 intersection. A,
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 56 _ 3964 Longitude 77 57 ° �23
Design Current
Design
Current
Design Current
Swine Capacity Population
Poultry Capacity
Population Cattle
Capacity Population
❑ Wean to Feeder
JE1 Layer
1
❑ Dairy
® Feeder to Finish
4160
JEI Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
Other
❑ Farrow to Finish
Total Design Capacity
4,160
❑ Gilts
Total SSLW
561,600
❑ Boars
Number of Lagoons L ` J ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps � ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes M No
b. if discharge is observed, did it reach Water of the State? (1f yes, notify DWQ) ❑yes M No
c. If discharge is observed, what is the estimated flow in gal/min? n/a
d. Does discharge bypass a lagoon system? (if yes. notify DWQ) ❑ Yes M No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: --------- Horth......... ......... Soul6......... --------•-------
Freeboard (inches). 30 42
n�in�ine

vaiwiv� t-untinueu
Facility Number: 31-102 Date of Inspection 6/28/2001 Printed on: 7/3/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ®Na
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes N No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? El Yes N No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? . . ❑ Yes N No ti\
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes N No
12. Crop type Coastal Bermuda (Graze) Matua Graze Fescue (Graze)
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?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Reguired Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes ® No
❑ Yes N No
❑ Yes N No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes N No
N Yes ❑ No
❑ Yes -N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
[j No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments:(refer to question #) Explain any YES answers and/or any recommendations or any-othercomments.
Use drawrngs of faciLty to better explamaituattons (use addttional pages as necessary)^ElFfield Copy ❑ Final Notes
- -
15. Field 2 Hydrants IA and 1 B are fescue in the waste plan; there are large areas of coastal Bermuda in places throughout this field. Thi
field is also overgrown with pig weeds. Need to work to establish fescue on the entirety of the field in accordance with the waste plan
and properly maintain the field. Field 5 needs spot seeding of fescue in early fall of 2001,
19. Need to transfer the application records from 2001 for fescue on hydrants 7 and 8 (this was field 2 in the old waste plan, it is now
Field 4 in the new waste plan) to the iRR-2's for 2001 using wettable acres. This should be done immediately.
tir
Reviewer/Inspector Name Stonewall Mathis -
Reviewer/Inspector Signature: Date:

r ,
05103101 Continued
Facility, Number: 31-102 Date of Inspection 6/281200I Printed on: 7/3/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ 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
or broken fan blade(s), inoperable shutters, etc,) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ®No
r1
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings

'Division of Water -Quality,
QDivision of Soil and Water;Cooservatton
Q'Other Agency io s
Type of Visit O 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 31 102 bate of Visit: 6/28120t11 Time: 15:00 Printed on- 7/3/2001
FO Not Operational Q Below Threshold
® Permitted ® Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold_
Farm Name: $:IRS.ttC. FAC1A............................................. County: 1?11D1LR.................................... WJR0 ......
Owner Name: •--------------------___-- Murphy.F&uljjy-Faxula--.---.---- Phone No:
Mailing Address: JPQ.1AX.759..........
.................................................................................. f?Sg. klliI................................ ........ .................. 4...............
Facility Contact .. Title: Phone No: ......................................
Onsite Representative: .J�hu_$�ziC------------------------------------------ Integrator:�pT�IDiIY�.�xiAS-------------------•
Certified Operator: Altaic ...................................... moble'y.......................
...................... Operator Certification Number:2525.9.............................
Location of Farm:
East of Kenansville. On North side (left) of SR 1959 approx. 1.7 miles East of Hwy 11/Hwy 903 intersection.
7
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 56 39 °° Longitude 77 • 57 23 «
Design Current
Swine CaDacity PuDulation
❑ Wean to Feeder
® Feeder to Finish
4160
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design. Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 4,160 :j
Total SSLW 561,600
Number of Lagoons L _ ` _J ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps j ❑ 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)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
n/a
❑ Yes ® No
2, is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier-- --------- XCrth--------- ---------- ........ -----------•--•-------- -- -•--.--------------------_ ---•-----------•--------•------------------•--•--•----
Freeboard (inches): 30 42

u�iv�iuf �.unernueu
• Facility Number: 31-102 Date of Inspection 6/28/2001 Printed on: 7/3/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Graze) Matua Graze Fescue (Graze)
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ®No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ®No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comm ents'(refer to question #) 'Explain any YES answers and/or any recommendations -.or anyother comments: -
W
Use drawings of facility to better"explain situations (use additional pages as>necessary} - r�"
-IE] Field Copy ❑Final Notes
15. Field 2 Hydrants 1 A and 1 B are fescue in the waste plan; there are large areas of coastal bermuda in places throughout this field. This
field is also overgrown with pig weeds. Need to work to establish fescue on the entirety of the field in accordance with the waste plan
and properly maintain the field. Field 5 needs spot seeding of fescue in early fall of 2001.
19. Need to transfer the application records from 2001 for fescue on hydrants 7 and 8 (this was field 2 in the old waste plan, it is now
field 4 in the new waste plan) to the IRR-2's for 2001 using wettable acres, This should be done immediately.
Reviewer/inspector Name 'Stonewall Mathis-`,
Reviewer/Inspector Signature: Date:

05103101
Facility Number: 31-102 Date of Inspection 6/28/2001
Continued
Printed on: 7/3/2001
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
[]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
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
❑ No
Additional: omments andlor D,rawmgs

DlWsibi of
0 gDlrsston of S� amd Water Conservadon u x
�.
Q Qther Agency
"
€
(Type of Visit JKCompliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint jSrFollow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
©Permitted O Certified 0 Conditionally Certified 0 Registered
Farm Name: g 4S r Go► {'h
Owner Name: Fay �� ^'► i
..... ..................................................................................
Z ®� Time: � 5.5
Q Not O erational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County: ... .......0 e 1 i.n
.......................................................
Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:..............
MailingAddress:..................................................................................................................................................................... ..........................
Onsite Representative:la It h g: i [.JAYL. �.i _%. t 4"� h�� Df!: rIntegrator: .. ✓ 1?.... 'r �'` ...........................
,........................ ...- ----. 1...
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��
.Swine
Design Current
Canarity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
'Design. Current Design T Current
Poultry Capacity Po ulaton Cattle -
❑ Layer ❑Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
7, Number of Lagoons ID Subsurface Drains Present ❑ Lagoon Area 10 Spray Fiem Area z
Folding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .... m.'Mh� ........... ....... M Of ................. ......................................................................................................
Freeboard (inches): _ Z
5100
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued on back

Facility Number: j — 1,0 Z Date of Inspection Z )S a Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[IYes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No.
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
IT 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.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0; Rio yWatidris;o;r• deticiendes mere h6(ed• during �his;visit.'• Yob Will -te -6W d further • ; • :
•:-icorre�oric#ence:a�autthis visit.:-: •:•:�:.:.:.:...:..... :.......-........:.:.•.•.:.•.•.:.•.•...•.•.•.•
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J-A(No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any, other comments. ;
Use drawings of facility to better explain situations. (use additional pages as necessary):
z ns ec�j)ah ca,.4vc4e4 4., Aolla:,� Up cvti ,ssve cie l ee-ey al-t r oLyaavi
e'r"� �ttgt't.k+ e4. T:��ere-lf yj r+N r Lizee- d i s40sred. �SSUe is s4; l
-a (,e re,sal wd ,
Reviewer/Inspector Name
Reviewer/Inspector Signature: PAA-01 ,q Date: _1 _I Sir 6 1 5100

.Division of Water Quality
Q Division of Soil and Water Gonserr%atron
Q Other Agency.
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint X Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: < < d� Time: 8 is- Printed on: 7/21/2000
3 � D �
Q Not Operational Q Below Threshold
Permitted © Certified Q Conditionally Certified © Registered Date Last Operated or Above Threshold: ....................
Farm Name: `PaS� i G ✓ wt .......... County: �lQ.l.?..n..........................................................
Owner Name: ....... �jy.ePk F...'.'.'"r.' 1.,, Pi.r n 5.........................
FacilityContact:.............................................................................. Title:.........................
Mailing Address: ..............................
Onsite Representative. !�Y, � �� � �.. [?��i�� ��
Certified Operator:
Location'of Farm:
❑ Swine ❑ Poutry ❑ Cattle ❑ Horse
PhoneNo:.... ............................................
PhoneNo:....... ..................................
.................................................................................... ..... I....................
Integrator: ..k.4 V ✓ `tL
,{:q'r...........O erator Certifcafion Nber:
Latitude Longitude �• ��«
Design Current
Ca ci Po vlatia
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Curt Design Carcent
Poultry Capacity Po elation Cattle Capacity "Po Ovation
❑ Layer ❑Dairy
❑ Non -Layer Ell ❑ Non -Dairy
❑ Other
Total Desi gp Capacity"
Total SSM,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
}Structure I Struct rc 2 Structure
Identifier: ..........................id �L
.................. .......
Freeboard (inches): �� +
5100
❑ Spillway
Structure 4 Structure 5
[]Yes �gNo
Structure 6
Continued on back\,

Fa .itity Number: 3 t Date of Inspection 1 12 Printed on 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
XYes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stLtures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding XPAN ❑ Hydraulic Overload
OYes
❑ No
12. Crop type �¢+�wt v®{Gi ia/ytZl. , F ,mye . M,e4yot. (QVerseM)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
JKYes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?,
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes �1�10
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
:: �'�10 •tiolaitotis ;or- d,i?Qci ndie ,s were hofpd• during this:visit; • Yoit will •reeeite iio further
• iror'responideitce_ abot f this visit.
Comments (ii6r to uesdon #): Explain any YES answers and/or any recommendations or any other comments
q
UsEdrawings of facility to better explain situations: (use additional pages,as necessary) --: —,-
S, —5 ceas erne( e44c,- wood ve ez4eJ;,P-N neeA 4o to •tmovcv( 1aVe>Dj
(+'+ be'-r1k^-t 4 tr1 Diccor4nle Wr41, yclDd / f ra.C4,'Ce5_
il. QVt�'� 1,c.�t#.'o►-t or rt tw4 A vGt, iaVe I`1 �`��o� �, oc6011-eed e11
%e[d NyA'--t+-%4 Z on_J' ie )�� ZD40 sr�uce'jl "a,�ti Z 8. J6s
q► vjq +ke Lono F sc ve on F elot Z ek
13. $e+rr" VeV, ;S feesen.} ih �`-se.ve, -FcetA 4. U)aek. 4o en ur e-���c�� cr p,•��
�r.Ac4ice A V'L LVI&A-We l A rt OLVV ;..1 eL leirit an4 ' /
e rwre �a �bel e-o a receive' CP o', sas l SA" )es-
Reviewer/Inspector Name
Reviewer/Inspector Signature:
a"Lcw-i!(
Date: 1 / l to l a ► 5)00

Facility Number: 3 % —�O Date of ItLspection J Qj Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below Cl Yes Cl 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 Iagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? _ ❑ Yes ❑ No
ityona 'Oomments and(or:I�ra► ings:
J
5100

IN Division of Water Quality -
Q Division of Soiland Water Conservation_'
Q Other'Agency. A _ e
Type of Visit �gi Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit IgRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 Q Z Dale of Visit: Time: �S Printed on: 7/21/2000
Q Not Operational Q Below Threshold
WPermitted 0 Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: ccS i C e. f ✓%1% Countv:.. � .... ..'........................................................
...................A........................................................................... t� �.
OwnerName* ........... .v.r. y..'..I..F .'`'! s........................... Phone No:............................................._........................................
Facility Contact: .................................r............................................ Title: Phone No
;Mailing Address:................................................................................................................................................................................ ..........................
Onsite Representative: / I i Ckjca eJ. A! o fe1 S� Jp n a� y + Integrator:... i .. ..........................................
Certified Operator: .................................. ................ ........................................................ . ... Operator Certification Number:..........................................
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 �4 Longitude • ° 66
Design Current Design Current , Design :'', Curl ent
k
She . Capacity Po elation,. .Poultry Capacity.. Population Cattte Ca Po elation
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Al [INon-Layer❑ Non -Dairy
Farrow to Wean
Farrow to Feeder -❑ Other
Farrow to Finish Total Design Ca ci
Gilts PS t3'
Boars TotaI.SSL--W -
w Nu uber of Lagoons I0 Subsurface Drains Present Lag-m Area 10 Spray Field Area
' - Rp-khng'Ponds / Solid Traps ❑quid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 5 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes JKNo
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑Yes 9No
e. If discharge is observed. what is the estimated flow in gal/min`? h q
d. Dees discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 7(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 4 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
�j _1
identifier: ....!.� .............. M.! 90(df -
e...................................................................................................................................................
Freeboard (inches): 1? 1Q
5100 Continued on back

Facility Number: ,31 — /� Date of Inspection / 2 Printed on: 7/21/2000
-5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, XYes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes RNo
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? 6Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ;�No
11. Is there evidence of over application? ❑ Excessive Ponding J'PAN Zf Hydraulic Overload
XYes
❑ No
12. Crop type �e ✓ r"`�d ra ZC B tl e MGi VC, OY BrsEGd
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMPV
❑ Yes.ONo
14. a) Does the facility lack adequate acreage for Iand 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?
OYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
A No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
.l No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
25 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
Z No
21- Did the facility fail to have a actively certified operator in charge?
❑ Yes
36No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(icl discharge, freeboard problems, over application) ❑ Yes }4 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes ETNo
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 O No
0. Io yi .bti jris:oi•• deficiencies -were itbfea• O&ing �his:visit: • You W' ilfteeei.ive rid fukther •. - :
:: corres}�otidence. abou this visit ::::....... ............. • . . .
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):
'Jr. %��,..,avt ��ce S l�ro►^� lq_goo,-, W,, L'i145ooQ( eYl�.n2Gritiq �rY1G�rcPS,
ll. dra.vl,G ovc-,-loaa; ck o� PAN o✓e at' Gave ocCc 1-fleA
40 1 ^^►�►^Ove leorgOdCh I V, SO one Qrcq 0-C �'e(0(
re,--,ove be,­m t r,+ be-&--- es4etbilsZ,-reSr.Ue o,,e✓n� i�}� of deed j{.
AL
Reviewer/Inspector Name 1s;10" [
Reviewer/Inspector Signature: Date: r✓ 2 0 v 5100

Facility Number: 31 —1 O v Date of Inspection FillQa Printed
on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or Flow
24Yes
❑ 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
JffNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
JA No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
Jf No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
M No
A-dditional Comments and/orDrawings:
1 lva�-1e plasm yleed9 b bz S,'gheal � dRled ba-Lvne.r.
�
9 . Se la lA k e so i Sa 1 s F", e lA q . Ee s v" 40 t/s�
preperl '016,geA W'9'5�& 01y"I s;s o+� ��12-Z�s� T3� S-vrc o
5;,-L
Use 6e5n� Pt9A/ Gil10W�c �2 FrD � � 14vn .* AJXR-V
�
e �
7� r•e� e d��'�re � s
l - �, � se e ��o p� ►►�� seO7'okl vSP a 04
5100

° = Division of Soil,and Water Consetvahon `.Operation Review. =z -,
Division of Soil and.Waterl-Conservanon;_-.Conipliance-Inspe tjoi
r e
'µ Division of Water t2uahty Comgliance Lspection _ x n 3
Ocy ther gene- Qperatiori Review ."` _. _ :� . 3
4
_ ..
12 Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted [3 Certified 0 Conditionally Certified 13 Registered 10 Not Operational Date Last Operated:
FarmName: ..?Ca....\...�-.......................................•--.._......_.............................................. County:.....__..._ .�1. ................. .._...........................
Owner Name: Phone No:---.............
................................................................._.._.................................................................
Facility Contact:.............................................................................. Title:................ ...... Phone No:
MailingAddress: ...................................................................................................................................................................
X
Onsite Representative: '..,.,., , Z ..•, , Integrator:...., I, ^\t---„---„-,-,
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
i
.................................................................................................... .. ............................................................................................................
Latitude = • � =A,
Longitude
• ° =11
' .,_ Current--
_. Design Current -_ Design Currnt
:
Capacity Population --.Poultry
nCalCaactPopulatde..
Ca achy._Po ulatioon
❑ Wean to Feeder
❑ Layer
❑Dairy
-
Feeder to Finish
Q
_
❑ Non -Layer
-
❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
i
❑ Farrow to Finish
=
Total Destgn Capacity
:-,,
❑ Gilts,
-=
❑ Boars
Total=SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Haldmg-Ponds P Y
/ 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)
c. 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?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ......... //... ................................... ............................. .......................................... ...........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
D�(No
❑ Yes
gNo
❑ Yes WINO
Structure 6
DR(yes . ❑ No
Continued on back
3/23/99

Facility Number: (late of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
I I. Is there evidence of ovgf application? ❑Excessive Ponding ❑ PAN
12. Crop type
S
ti •
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: No irioiatigris:or• die flcienc;ie-5 •w.ere nQfed during ihis:visit: • You �viil •teeeiye 1iti.i furtheri.• " • "
C . . . phi [deuce ah4r i this visit. � . • • : : • . • : • .. .:. .: • - •
❑ Yes XNo
aYes ❑ No
❑ Yes gNo
❑ Yes $No
❑ Yes X No
❑ Yes Dj(No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes ❑ No
Oyes ❑ No
❑ Yes No
❑ Yes ($( No
❑ Yes 9No
❑ Yes No
Yes ❑ No
❑ Yes 12INo
❑ Yes P No
❑ Yes N[ No
❑ Yes ffNo
❑ Yes ONo
❑ Yes J2� No
Corriments (refer to question #): -Ea�plain any.YESanswers'aaad/os:any recommendations of any other comment§:
Use.drawings of facilitv tobetter elain situatioadditionapages aAL
s necessary)
S� � �"� �� �S Gam '�S ��d. � I�Q.►-- Sl��`� �r � ^ 1l `� � cc��, L�G�.�
Lk
areA -'\ �\ c",�,� e rive L�► '
Reviewer/Inspector Name
Reviewer/Inspector Signature: ���, Date:
3/23/99

y [Facility Number:3Date of Inspection.
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below zYes ❑ 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 ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 5�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 VrNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes qNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNo
AAditional.Conunents: and/or _swings _ - _.. aVJ
Sqq �c
(
3/23/99

❑ DSAN, C Animal Feedlot Operation Review
DN17Q Animal Feedlot Operation Site Inspection
I&Rautine OConinlaint OF(iliom--uT)(irD%,%:Oinspection 0 Follow-up orDSWC review 00ther
Date of Inspection
Facilitv Number
I - - I Time of Inspection iJjp 24.hr. (hh.rnm)
13 Registered Q, Certified E3 Applied for Permit' ;d Permitted 10 Not O eratianal Date Last Operated:
Farm Name: _A�a__I� CNL11_1_ County: n1i,
Owner Name: Phone No: -(-IN Q)_2_4___2j1ff
Facilitir Contact: Vtl �L&WS Title: Phone No:
Mailing Address: _20 ---
OiMte
Certified Operator; Operator Certification Number, ---
Location of Farm:
Latitude Longitude
.-..Df!Sign'.-'L.4Current..r:.',.'��.::::..�..�.,::-:,z.::-Design;- Current.. esma
D
-Population, Cattl
:Swine:Upacity.� -Population Poultry e "CapaiHtv
We -an to Feeder
Feeder to Finishj�
E3 Farrow to Wean
El Farrow to Feeder
.-;.10 Farrow to Finish
Gilts
Boars
FE]Subsurface Drains Present 110 L2,voon Area
uniber of -oonsl-Holding�Ponci�_�
No Liquid Waste lvlanagementSvstem
General
I. Are there any buffers that need maintenaticcFimprovement?
2. Is any discharge observed from any part of the operation?
Di4zcharge originated at: [] Lagoon 0 Spray Field ED Other
a. If dischanat is observed, was the conveyance man-made?
b. If dischar-n—c is observed_ did it reach Surface Wam," (If ves. noiit-- DWQ)
c. If discharge is obszr-%�ed, what is the estimamd flow in galimin)
d. Does discharge bypass lagoon system? (If yes, notify DWQ)
r, - - -
3. Is them evidence of past discharge from any part of the operation?
4. Were there anv adverse impacts to the waters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
man nmnanCC/improvement?
6. Is faciliry 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?
7125.197
Spray Field Area T',
El Yes
1XNo
0 Ye-q
No
ID Yes
No
El Yes
No
D Yes
ED No
ED Yes
No
ElYes
No
El Yes
q9 No
El Yes
1P No
El Yes, No
Continued
on back

�I
Facility Number: — OZ.
8. .are there lagoons or storage ponds on site which nerd to be property closed? ❑Yes ($\.o
Structures (1-2-goo c,Holding Pondc, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes NINo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Z=` S16,
Freeboard (ft): Z
10. Is seepage observed from any of the structures? ❑ Yes 12 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)
11 "Do any of the structures lack adequate minimum or maximum liquid level maskers? ❑ Yes ® No
Waste Anntication
14. is theta: physical evidence of over application? 0 Yes W No
(If in excess of WMP, or runoff entering, waters of the State, notify DWQ)
15. Crop type i P"CuP----Sna(LL
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes � No
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 agmncy?
21. Did Reviewer/Insp-„ctor fail to discuss review inspection with on -site representative?
22- Does record keeping need improvement?
For Certified or Permitted Facilities Oniv
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.viojafoits or deficiencies. were- noted- duiing this:visiL- Y.ou.v6U receive no ftiri-her ' -
Corr esporidence aboid this visit- _ ..:...:.: .
Yes ❑ No
[Yes D No
❑ Yes ERI No
[�bYes ❑ No
❑ Yes 1Z No
PYes ❑No
❑ Yes W No
KYes ❑ No
PU Yes 0 No
I�-Az- (ct-5 LJ�` tJ��'� 6i, S�Q� O \� I�j�LO�[C� �ti t'!tiL cA. dill (fha�� C �T �[JC� ia"i[3Cas. t
Cc" rnw�t?' 56.4 b,5stt^nnb V01Q rr� S fmG,TLI �o� It' Concr►'Vlr ` ' _
t�LroU • l �L CrKcs or, 6i, , Co, d-, ( w 1 � S Yled rv-v - K Lit i S e
L S f vt 6i�lc1 by x{-c> —dAi, d f:� cif s a �� r!a� ccn S1,a,;� � e "laA.
-� o- cL-6-vro� rtrcy c (t /'v.e `''� S c, e . ir� 1 x �[ c� gf'�-eb,
uk
t�_�Cer��i,u e � �oris 'k irn ,fcre tynV! �WUAO'- w` bernt;e�6L �f � -"
1'1./u. GYM':+ st'CL'O 6, ci�deCJ ' O i't- W�. [ " �-C % �w �Y`YF� 4b i`QI'a'� .0 CGiL7S
c � ors S c r �1� a..c.�r-c• ��- 'b �m u �n � r a �c.; #• V�--�' n � �1r e� e�.. � i z Uo.�•u
Zzr`(' �Lje�S ir• �'e�] i301 1 lZ��, ien f 5a:1 5i.,e41-4+ 1W ASs SfAue.e,7125197
..
Reviewer/Inspector Marne
Reviewer/Inspector Signature- 9?li.��� , J Date:

v 4.0
FFac7ifl. -Number: ....... Date of Inspection:
,Additio-nal°C6n-im6nts'and/or Dra"wings:"
/4 c W 0
IOS
N
4/

El DSIVC Animal Feedlot Operation Review
DNVQ Animal Feedlot Operation Site Inspection
I%Rijutine 0 Complaint' 0 Follow-up or DNN'Q inspection 0 Foil ow- up of usivc rejem. 00ther
Date of Inspection
Facility Number Time of Inspection 0) 00 24-hr. (hh:mm)
E3 Registered Certified Applied for Permit' Permitted JE3 Notperational Date Last Operated:
Farm Name: — __ - ------ — ----- Counti-: ...... . .....
Owner Name: fi�Yrr\ll ..a�: . . ..... Phone No: -
Facility Contact: Title: Phone No:
Mailing Address.
Orkite Integrator----- . ... . ....
Certified Operator; Operator Certification Number -.---.-
Location or Faun:
Latitude 0 1 Z& Longitude 0 f 44
awean to F
kir
—D I�esigw �,.'-Current- ..-"Design�:, :Current.,...,.
-C
p `Poultry.'apaqty OPIL
-Ca acity.l.-PopulatioiL,-, -Toult' `.� - apacitV. Population, Cattle i:.­
_10 Laver airy
10 Nan -Laver "nNon-Dairyl
10 Other
'Total Design Uapaci
Total S SLW..
4.Niunber of Ia201, 10 Subsurface Drains -Present ❑Lao oon Area
Spray Field Area
No Liquid Waste Management System
General
I- Are there any buffers that need mainteriancehmprove-ment?
ID Yes
EXNO
2. Is any discharge observed from any part of the operation?
El Yes
No
DiRchars!e originated at: 0 Lagoon El Spray Field D Other
a. if di.,zcba-!!-,. is observed, way the conveyance man-made'
❑ Yes
No
b. If dis-har-2c i,, obscned, did it reach Surface Water? (if yes. notil�-- D'V",Q)
❑ Yes
50 No
c. If dischar!,e is observed, what is the estimated fioxk- in !-aUmin
AJ
JA
d. Do-ts discharge bypass lagoon system? (if Yes. notify DWQ)
V - -
EJ Yes
I
51 No
1 Is there evidence of past discharge from any part of the operation?
ED Yes
ITJ No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
E3 Yes
T "No
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
D Yes
[P No
mainteriance/improverrictit9
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ED Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
El Yes
[P No
7125197
Continued on back
eeder
Feeder to Finish
❑ FarrowW,,,qn
Farrow to Feeder
El Farrow to Finish
—Gilts
0 Boars

[Facility -Number: 3.1 — 10Z
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
JX No
Structures (LaaonnsHolding Ponds, Flush Pits. etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
0 Yes
CZ No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier. _ 2
Freeboard (ft):..
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)
13. tiDo any of the structures lack adequate minimum or maximum liquid level markers?
D Yes
® No
Waste ADDHMt.ion
14. Is them physical evidence of over application?] Yes 1) No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type-
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWNIP)? ❑ Yes W No
17. Does the facility have a,lacl: of adequate acreage for land application?
1S. 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?
O - No .violations or deficiencies. were• noted- durins this:visit-- You _v�ill receive- ho further :
eorn spondenee Aboat fhisvik,.; . _ ... ;
AYes ❑ No
[�IYes ❑ No
❑ Yes 1Z No
PYes ❑ No
❑ Yes VI No
*]Yes ❑ No
L] Yes XNo
Yes 0 No
it Yes ❑ No
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Reviewer/Inspector Name
Reviewer/Inspector Sigmture: j am/ , J Date:

Facility Number: Date of Inspection: 27-
AdditionaF'Coniments and/orDiA in
Dv4.r G.�-.e� . T K G-�c,U.ti ate. S� r-i.C�r�S 15 � �b$ �aG. Ll� IJt� � i �}�
4/30/97