310113_INSPECTIONS_20171231

NUH I H LAHULiNA
Department of Environmental Qual

U
af:Water
Facility Number 113� ODD"Anon 1of Soil and4Water Conse ahon ��
x�� .. w ,
" .Other
type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �utine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: � Arrival Time: p.' Departure Time: County: nL_-r�— Region:
Farm Name: bc) .,s , Ida �� lr-�a d ng Owner Email: -�
Owner Name: bi, 1�" ` ,..ems / �2�i�r5 ��hc � Phone:
Mailing Address:
Physical Address:
Facility Contact: �d �,-�/yjp�•^z _ Title: r Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current = M �' Design=nCbrrent t°Current
�" .� Design
Swine
Capacity Po Wet Pon „ Ca act Po Cattle Ca act Pa i r
P tY p' rY P tY P P ty P
_.. f
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
Da' Calf
;
Feeder to Finish
c`�
Y `: -
kr _
DairyHeifer
Farrow to Wean
,Design Current "-
D Cow
Farrow to Feeder
�D �PoultCx act ,."Po
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feedera
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
t
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes [:]No
[—]Yes [:]No
❑ Yes [:]No
[]Yes [S No
❑ Yes E&No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA FINE
❑ NA ❑ NE
Page I of 3
21412015 Continued

Facility Number: - / 3 1 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O—No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): I
Observed Freeboard (in): ;3c)
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
[2]-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes MNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes f"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): ems/' y sz,,4r
13. Soil Type(s): ��.�'T r/11
;1�,�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes allo
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes A 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 JS No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [a No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili 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 �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
❑ Yes &No ❑ NA ❑ NE
❑ Yes f No [] NA ❑ NE
❑ Yes 2, No ❑ NA ❑ NE
❑ Yes Uj4,No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date: "�
21412015
Page 3 of 3

—VDivision of Water Quality V
acility Number Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit LLe6tnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 91JRoutine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region: (� r
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: i ' CO(O
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator: ry" �• 7
Operator Certification Number:
Back-up Certification Number:
Latitude: 0O=, Longitude: =o=' 0"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
j R I ❑ Non -La er
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 Cowl
I
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?
❑ Yes ❑14o ❑ NA ❑ NE
❑ Yes
.0110
❑ NA
❑ NE
❑ Yes
;'No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ZNo
❑ Yes
ErNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 1'J No ❑ NA ❑ NE
12128104 Continued

Facility Number: - Date of lnspection: /G�
4
/l
/
WasteCollection & 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
F3-No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Z Lj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 02- r
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
Zf No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
YJ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[,-2-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[XNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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
[� o
❑ 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
D Yes
Ea No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
&No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
["No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [?"No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes E:fNo ❑ 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 [�rN o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ErNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J:3 No D NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - 11,1 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �jNo
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes Z No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EfNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes C�No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes Callo ❑ 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 ZNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No ❑ NA ❑ NE
Comments (refer�to question,#),Explain any;:YES-answers and/or any additional recommendations or any other comments.
use drawutF_s,o 'f'facility to_betfee- explainsituatians (use;addilional pales as,necessary)..
er-<<�'t:5 1e-1 �-r sjr/ ls�'- /-dao^ ru
o " ore6 r�3 ldc)le�'au.?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

Division of:Water Resources
Facility Number F7T7 0 Division of,Sori and Water Conservation
p other Agency
Type of Visit:6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
I .
Date of Visit: Arrival Time:
-
Departure Time: O County:
0j-
Farm Name: /p' &0�1s
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: MIntegrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
,I ffg2
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other'
Other
Latitude: Longitude:
Region: ''"-ti`�`rJ
Design Current Design Current
Wet Poultry Capacity Pop w Cattle Capacity Pop
La er
Non -La er
Design ;Cuen rrt
M Dry P©ultrv= , V ...Capacity N . Pon
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes .E]'No ❑ NA ❑ NE
❑ Yes ff 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 [EI'No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Q o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [fl'*No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: 3 Date of Ins ection: 3 t'2
Waste Collection & Treatment
4. Is,storagt;.capacity (structural plus storm storage plus heavy rainfall) less than adequate? es ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:],No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1:]-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes 12-No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? \ es Z/ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �❑i '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 V_V'Yes RNo ❑ 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 E3 No [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
,EJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Eff No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
J2"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
C:�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
P�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
0No
❑ 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
21412014 Continued

Facility Number: jDate of Inspection: ."t.
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes PNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes E No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[—]Yes P�No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ]10
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [2^No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes E ' o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes �' o
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes P'l-4o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
TT
32. Were any additional problems noted which cause non-compliance of the permit or CAWNT?
[:]Yes �o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ;2"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No
❑ NA
❑ NE
Comments (refer to'question ft Explain any,YES answers and/or�any additional recommendations. or,anYIother comments...`
Use drawings offacility,to better explain situations (use"additional:pa'ges as°n'e`cessary):
-
PCtirn.e l 1c15oo v, . ie,,jr
+ fq�4- yle t i• S SC-r Y Ct,CA_1Z its
i�J s 1p, (14 e s yva_�_ fLt
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Z4 _! Phone:?
e
_ _ _ Date: 3 Z
21412014

Division of Water Quality
Facility Number "� O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: aCompflance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: GKRoutine 0 Complaint 0 Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: ArrivalTime:1 Depiirture�Time:"County:
Farm Name: V.5• /UI A g&'y1 AAV-W4 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Greer &orc
Certified Operator:
Sack -up Operator:
Location of Farm:
Swine
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Title: Phone:
Latitude:
Region: V. At
Integrator:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Ja er
Non -Layer
Design Current
Dry Paultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity. - Pop.,*-,-.
Dairy Cow
Dairy Calf
Dairy Heifer
Da Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes JoNo ❑ NA ❑ NE
❑ Yes
�TNo
❑ NA
❑ NE
❑ Yes
V] No
❑ NA
❑ NE
❑ Yes P No
❑ Yes ZNo
[—]Yes ZINo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: j - jj Date of Inspection: ; .r.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Pj No • ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 3 D 3a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes a No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes eNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [7P 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 eNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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 Uf�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes VTNo ❑ NA ❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes VfNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes FNo
❑ Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes No [] NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis D Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes `7 (o ❑ NA ❑ NE
. Page 2 of 3 21412011 Continued

Facility Number: - j Date of inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? El Yes TXNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
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
INo
❑ NA
❑ NE
❑ Yes
rjNo
❑ NA
❑ NE
[:]Yes
;allo
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes 4No
❑ Yes VTNo
[:]Yes 0No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question's Ezplain any,-YES:answers;and/or�,anyraddtfional reeommendations ormny outer comments.,
Use drawings,uf facilrty�to b'e#t rex lam:situations us6 addrtjonal; a es°as:necessa
Reviewer/InspectorName: --stwS�� U^, Phone: tv-)
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

UDivision of Water Quality
Faeility Number- 1 3� O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Compliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: jU Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 3 g 13 Arrival Time: ® Departure Time: tj j] County: N Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �SRf�E� aft i✓
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
:.Other.. _
Other
Latitude:
Phone:
Integrator:
Certification Number: 9 `-T
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non-Layer7J,
.r r
Design. Current
Dg Poultry.Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cattle
Design Current
Capacity „Pop
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef B
rood Cow
❑ Yes C211No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ o
❑ -Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - 'J Date of Inspection: g 13
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes MINo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2
Identifier: LA6tmm L.IAC Com 7—
Spillway?:
Designed Freeboard (in):
❑NA ❑NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): 2_1 S_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[:]Yes E fNo ❑ NA ❑ NE
[:]Yes C/3No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? t Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes I_J /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 dNo ❑ 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
[l No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
& o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
W
❑ 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes fNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3 -
Date of Ins ection: 3 1 1
24. Did'the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes L]r<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes E(NNo ❑ NA ❑ NE
❑ Yes [3/No ❑ NA ❑ NE
❑ Yes %/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[7�No ❑ NA ❑ NE
[� ❑NA ❑NE
No ❑ NA ❑ NE
Reviewer/Inspector Signature: Date: ?j
Page 3 of 3 21412011

t Division of Water Quality
Facility Number 0 - i 1371 U Division of Soil and Water Conservation
O Other Agency
Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency ()Other O Denied Access
Date of Visit: Arrival Time: 4� Departure Time: County: Jar`
Farm Name: Ly . S . Mjgj7HE w S 6:�ACL1+1 S Owner Email:
Region:
Owner Name: �� . 1 I J /�T71�
E�1S
�� S /iVC
Phone:
--
Mailing Address: Q3 S Q1L.L L-k
I 1 ,4-27-146
(.JS lei
( UCl; U
NC— 9?3q3
Physical Address:
Facility Contact:
Title:
Onsite Representative: G Q,6( 9- ff \03Q_
Certified Operator: 1. � LU 07
Back-up Operator:
Location of Farm:
. Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Phone:
Integrator: n p
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I E�La er
Non -Layer
Poults
Design Current
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cattle
Design Current
Capacity
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ko ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Stru ture I Stru ture 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ---
Observed Freeboard (in): 9 Ll (9�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PP No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
�T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ix 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
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �(L-�> r1 5 �� tl eI
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 ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
4
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
[]WUP ❑Checklists 0 Design 0 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes t�No ❑ NA [] NE
0 Waste Application [] Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ W/te Transfers [] Weather Code
Q Rainfall ❑ Stocking Q Crop Yield 0120 Minute Inspections Q Monthly and I" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I
No [DNA ❑ 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 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 I ](I No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
TTT
❑ Yes U"' No
NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes N No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes IM 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
0
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
_W
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes aNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes jo,'No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or, any other comments.;~
Use•drawings of facility to.better explain situations.(use additional pages as necessary).
5 L� L_oO& V G C_,GGOH bjF7 SIG,A1 f--o�L q3 j (5 t-A-G ooA/
od N I S C---.)- L `xz. 463 LL. )kAS A 5 7 H G- )9 f- C
w..4y
I vjraJll
<6,1�c,1►1
aYsa
Cy
),
�U,Aj
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
c�hs
11Ira to
jaly —,s> 1-41LI
L'._�)L'L-6r !N IMP jL~T309LA
Phone: 16 -'13 0
Date:
Page 3 of 3
21412011

Division of Water Quality
Facility Number ] 0 Division of Soil and Water Conservation L'
- 1 0 Other Agency
Type of Visit ACompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit'�LRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l 51 Arrival Time: ® Departure Time: County: �'l� Region:
�
Farm Name: ` }c i r Ar! a7TOeA,"S5 F19 lM S Owner Email:
Owner Name: 7 7 W 1 !Yl AI a Phone:
/ Y C�
Mailing Address: a`�S `� � C—(� � I ' +,/�I� J�'7Ti�E�S C� � �� �"� eq
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: — IntegraWr:: `
_r F�� 1
Certified Operator: 0� H—�� f ��/NSQ�1/ Operator ertification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 0 = =66 Longitude: = o = ` = "
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 Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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
XNo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
ElYes No []NA ❑ NE
12128104 Continued

Facility Number: 1 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: .S M 1
Spillway?:
Designed Freeboard (in): �.
Observed Freeboard (in):
5_ Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan? ,
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes *o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ElNA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?�No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ElNA ElNE
❑ Excessive Ponding ElHydraulic Overload ElFrozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 6 a L C O e Ai � S�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,Pq No El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L No ❑ NA ❑ NE
M. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 5 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
ElNA
ElNE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
[I NE
Comments (refer to question#). Explain any 1'ES:ansRers and/or any:recommendatroits or.any oth'erfcomments, t y s
Use drawings of facility to:betterYexplain situations (use additional pages as necessary)
t
Reviewerlinspector Name Phone:
Reviewer/Inspector Signature: Date:
%
Page 2 of 3 ­_1 12128104 Continued

R Facility Number: . — 3 Date of Inspection 3,!
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 0,No []NA ❑ NE
the appropriate box.
0 WUl' G Checklists El Design El Maps ❑Other �,.�(
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes L)Sl No ❑ NA El NE
El Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ uiaste Transfers ✓ ❑ /nnual Certification
El Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and V Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �kNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ANo ❑ 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
XNo
ElNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
❑ 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
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesJNo
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional ;Comments and/or Drawings:��, ,
CA(,►aW7K�N oUE a
NGU"_� 01C
anti/»
81u1�o
,.o J.►
FRS a S r N �tG I A6WIV
Page 3 of 3 12128104

Division of Water Quality ��
Facility �Nlimber- `3 / J Q DwIsion ofSod andxWalerConseE Vatlon<'t x, ' wv - ��
m.
.. - - .. .. .O OthC-Agency
Type of Visit .Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 9 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Cj [� Arrival Time: ® Departure Time: County: Q/✓ Region:
Farm Name: W_ S . 1 r Mig TgewS FACLm Owner Email:
Owner Name: W • S g7aatn by c Phone: U6 —296 34 0 Q
5 f3/c_� MA 7NCws �! U t AC QS39
Mailing Address: T
Physical Address:
Facility Contact: Title:
69-L—C—s—
Onsite Representative: 6�0q-e
Certified Operator: Pki jL, D 2 . S ANOC-QSdN
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
Phone No:
Integrator:
Operator Certification Number: 19,.
Back-up Certification Number:
Latitude: a ='
[—] Longitude: = ° = =
Design Curi
Wet Poultry _ Capacity Popul
=Dry Poultry, w p
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
ErTurkey 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?
i ❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
' ❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cor
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes *No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ YesNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: — �f
Date of Inspection M=
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
El NA El NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (�I to (n QLt_
❑ Yes [No
ElYes ❑\l No
Spillway?: Designed Freeboard (in): Ig
Observed Freeboard (in): p( (9 _E�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes )�rNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? ❑Yes W] 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 El 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of 'Wind Drift ❑ Application Outsides of Area
12. Crop type(s) Caw Is C W HE,4S
13. Soil type(s) CAiJ
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P(No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
GkrNo
❑ 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
"�j No
❑ NA
❑ NE
Comments (refer to question #) Explain anv YES answers and/or any recommendationsbor•any,� other comments.
Use drawings of facility, to better g*plain situations (use ad kti6nal pages as n' ecesLin
,
a.
Phone: ' toga ReviewerlInspector Name
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. Q W­UP [] Checklists Design [I maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes *No ❑ NA ❑ NE
❑ Waste Application ❑Weekly Freeboard El Waste Analysis El Soil Analysis ❑ V & Transfers El Ad nual Certification
0 Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections 'El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10No
❑ 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
)4No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ 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
'a
El 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
kNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
1
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
6Q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
_Z� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
_j6No
❑ NA
❑ NE
Additional Comments and/or Drawings:
pqcLc&_,Q(LiC_ S&,V T /A/ i o CH,41V66 01G e,--4 B 1► 4LS -TU �)H1up SOX069-SCA/ AL
Srn crE,QV'-- A r $1C cal-GoGiV —.. -jA4&N CAQd Car-
e�FoR�
�.A, s
CACAGa011 CW
12/2&04

. Drvrsion of Water Quahty f
Faility, N�Umbers �j ] ] 3 O:DI� �sion of Soil and Water Conser�ateon
U _ Q-.Other Agency
Type of Visit
&ompliance Inspection
O Operation Review O Structure Evaluation
Q Technical Assistance
Reason for Visit
X Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: T-d=� Arrival Time: Departure Time: County: Region:
Farm Name: M A-Ml E W S F A (LEnS, Owner Email:
Owner Name: r��� 1 r )PMMEl �S 'FAA MS INC Phone: !2/o-9 90 -39'Q.Q
Mailing Address: NL�S �11� f i!/ 77 EC JS � � aK E� 'i %IC, Qo��J3 _
Physical Address:
Facility Contact: /� Title:
Onsite Representative: (2'-ap—e-L 1 ,/� V oc -E
Certified Operator: _ fa m i e_ Lee- G& KF=v_
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
LI Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number: 01 a89 P
Back-up Certification Number:
Latitude: = o = . = Longitude: = ° = 4 [= "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
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 �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
O�No
❑ NA
❑ NE
❑ Yes *o ❑ NA ❑ NE
Page I of 3 12128104 Continued

Faciiity Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
El NA ❑NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Sfi1gLL L_g"r_
❑ Yes V No
❑ Yes ❑ No
Spillway?: n
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes WNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ 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 JANo ❑ 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 C.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? 1
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[7LNo
❑ 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.
_J G 5 1�6
Crop type�j s) _ l QNN� c'nQ-XI W wr--a 1 e
13.
Soil type(s) AjaQ:>
i-n in )�L A
14_
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
IoNo
❑ NA ❑ NE
l5.
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
DQNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
KNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
;KLN0
❑ NA ❑ NE
Comments (refer'to.questioti,#) Explain anv YES answers and/or any recommendations or any,,otner, comments ,*
Use draw•rags off, 'ility, to better explain situations. (use additional -pages as necessary) .
rCgo n rev SmAci L04 Goofy Is a"
3 ) g jai �y ►/j31 a�
(;9P&W, as
.q 1a9 910
Reviewer/Inspector Name � T L��S Phone: Cj'/d 9(D-3 1"l
Reviewer/Inspector Signature: Date: 3li(o1-0-1
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
TT�
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
D .No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
ElNA
[:1 NE
El appropirate box. ❑ WUP Checklists Q Designs El ❑ Maps Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soii Analysis ❑�aste Transfers
❑/nnual Certification
0 Rainfall ❑ Stocking ❑/rop Yield 0 120 Minute Inspections 0 Monthly and V
Rain Inspections
[] Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
f4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JK No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
4 No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
PSNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ 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
XNo
❑ 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
15�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
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
3Z�bjo
❑ NA
❑ NE
he Ted S pC,
A��i�I C w/ C� 1G *0LA_WE � , SOMrc � �Pc.oc�EG S *ROE
e4 R� �D�NC T � c.I �Y} RJR- r/Y cs¢�cT l4 n
g 0
o,Al How i d f igeKer--S .
Page 3 of 3 12128104

Division of Water Quality /
Facility Number 3 % f 3 O Division of Soil and Water Conservation ✓/
O Other Agency
Type of Visit W Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit M Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 to aF5 Arrival Time: %a ° Departure Time: County: U Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �/+'� i Title:
6kE12
Onsite Representative: /I ``f" p igea
�
Certified Operator: AM t is C� rt 9,4 �^E�
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
�o
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: 11984 360
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
YI [ J❑ Non-Layet
Dry Poultry
Non-L
Pullets
Poults
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?
Longitude: a ° 0 =
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 0q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
DqNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104 Continued

Facility Number: S 1 — j j Date of Inspection ��-1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3) -I I r-L CP% 3 i -1 ! 3 LA
Spillway?:
Designed Freeboard (in): ar���q _ ��• S
Observed Freeboard (in): O' O 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 1�rNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 4No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IN No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes A -VT No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZETNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
f� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
:R No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewerfinspector Name flrmAta4 6,gwCS I Phone: qgi 1-3g�'13.24
Reviewer/Inspector Signature: C3 AV Date: 3 / / Q I6 8
12128104 Continued

Facility Number: 3 — j 3 Date of Inspection 10
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )w No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes %No ❑ NA Cl NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 10 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;a No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
kallo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
DR No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
INo
❑ 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
UffNo
❑ 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number Division of Soil and Water ConservationL 00 �_
0 Other Agency
Type of Visit 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g O Arrival Time: ' parture Time: County:
Farm Name: 1}T%t�/5)/f �j1!'1S Owner Email:
Owner Name_ Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: �f Title: Phone No: %� ,,
Onsite Representative: / t' �2_ / ' /(MI-1; _ Integrator: iiiP�h�/ " � qz 1")
Certified Operator: ���� � & Fwz 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
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: [= o = . Longitude: 0 ° = d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkex Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[]Yes PNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes {� No
El NA
El NE
❑ Yes / No
❑ NA
❑ NE
12128104
Continued

Facility Number: 3� —�� Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
/P(No
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 2
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �No
❑ NA
❑ 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 ElNo ❑ NA ElNE
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 El NA El NE
maintenance or improvement?
Waste ADDlication
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 o ❑ 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
El Evidence
eoof�Wind Drifl ElAp lication Outside of Area
12. Crop type(s) 4e,9 6e 65__xo�, J,L�.N6/6r6, L.r/
13. Soil type(s) eQ , Al IZ
l4. 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
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
I--]YesNo
❑ 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 A Phone:
Reviewer/Inspector Signature: Date: . r O
12128104 ' Continued

• - r
Facility Number: —�/'�, Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA JZ�NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ElNE
the appropirate box. ElWUp ❑ Checklists ElDesign ElMaps ElOther Zd
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] 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 ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
,IzNo
❑ Yes JL1 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes /9No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes gNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
ONE
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? (ie/ discharge, freeboard problems, over application)
/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Q p
12128104

Division of Water Quality
Ft3ci�ity'Number j 3 0 Division.of Soil and Water Conservation
Other Agency
Type of Visit (6 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 J Arrival Time: Departure Time, County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 0 Pt,)r.� GLA C_AA�
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 4 Longitude: = ° = 6
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish to
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ez
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockez
❑ 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 E3 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
2�4o
❑ NA
❑ NE
12128104 Continued

Facility Number: 31— 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2rNo ❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
CfNo El 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 thre t, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9--i to ❑ 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
31" o ❑ NA
❑ NE
maintenance or improvement?
Waste Apl2fication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ETNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 911 o ❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s) Z Ck_"'vDA C i-AD 5 G O
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? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EfNo
❑ NA
❑ NE
El No
El NA
❑NE
E No
❑ NA
❑ NE
04o
ElNA
ElNE
C� o
❑NA
El 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)::
15,E W�E.i GoNT2.ok� NE.��c-(� �iJ SoM� t�oa..rie�L- LA`�.1-IG �SL-Lr,�S
a�,� y►psrE AP9LzC.r o0 cw( (R, k,. Pam- Ac-P-L- ( 00J CAFo 9 ?STC yv� WILL Pn-Z.1'4A-r
mTs LAk,c vt.AT'%�- ) Yeec) Ax/AduAL— CA—f T P-PD Moct.TAk-- .T_ ' Wmr�l 2EC,�-K-0s (SENT)
LxP' 04-r(= C n_o P k? �s CZ- tv► . CA Q iz �T TQ G S E.E 9 T� �a C�7f
w ASTE AWfNLY5ZS tea CPO OAys; PR=0P— laNO AF`IER .3 AmPc.c_ 1JATC,
Reviewer/Inspector Name _.. - . a0kL_ I EW-. --- Phone: ('51071;1, _'7
Reviewer/Inspector Signature: 66�Date: / --/1 3 0
f 12128104 Continued

Facility Number: — {3 1 Date of Inspection
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 1 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does ord keeping need improvement? If yes, check the appropriate box below.
L/J Yes
❑ANoo ❑ NA
ElNE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis El Soil Analysis ❑ Waste Transfers
2nnual Certification
❑ Rainfall Stocking OJ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
hd'No
E No ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
EYes
❑ NN WA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El yes
E& N
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No 7NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E o
❑ 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
210
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
�,�
,1J,1VNo
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
E No
❑ NA
❑ NE
AUd
iti u'alCominen'tsand/orDrawugs,;�i go
12128104

Facility Number jDaiteofVisit: Z 1 Time: ILJ_OiL.J
Q Not rational Q Below Threshold
EI'Permitted Certified 0 Conditionally Certified ©Registered ]Date -Last Operated or Above Threshold: ...�....
Farm Name: ..W SOo�'?__.�b�A�`�.......�....�:z..._om�`..'�"�_._.................._�_...._ County: �Yr.»».................__..........�...
Owner Name:
Mailing Address:.._ _. - - .. .... ... .... . .
Phone No:
Facility Contact: Title:._ _ . _ _ .. _ . Phone No:
Onsite Representative: L N_A fJCAE' fZ-D . integrator.
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine 0 Poultry ❑ Cattle ❑ Horse Latitude • A « Longitude • ' «
I)esig�i '.CnrrentS Desa� L Curtrat " . DesagnCarreat
-r
.Cattle i on
wean to Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discbarees & 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? than 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5�
Identifier: Se _I SU2Z_ .
Freeboard (inches): � 3o
❑ Yes [�`No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
Discbarees & 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? than 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5�
Identifier: Se _I SU2Z_ .
Freeboard (inches): � 3o
❑ Yes [�`No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ YesE:I/Na
❑ Yes
dNo
❑ Yes �No
Structure 6
1
2/I.2/03 Continued

Facility Number: 3 ( — [ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [dNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes dNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes [�No
9. Do any stucturres lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes VNo
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenanceAunprovement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes WNo
❑ Excessive Ponding ❑ PAN [IHydraulic Overload ❑ Frozen Ground [ICopper and/or Zinc
ap
12_ Crop type ece-iML)V-A 5G0
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 CjNo
b) Does the facility need a wettable acre determination? ❑ Yes E�&o
c) This facility is pended for a wettable acre determination? ❑ Yes ElAo
15. Does the receiving crop need improvement? ❑ Yes �40
16. Is there a lack of adequate waste application equipment? ❑ Yes ['No
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ Yes WNO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RfNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes DINo
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 Cj No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
7�) F� t4L� JE-Ii o u t�R �,� is�E. T�,�n E)cXa Qz.ec�- — T�/
32.ta oz / Ac�c.E 'I k Z S C)c G 6rjs rt11 � i IJ C 27 na b / Ac n-(��
rwt13 �i (� �. I
PUu i�-Y"�6 Z' fSG 514-6
35,) kE�P ST��I +-�G �a- Af4? A*�+Juwi. G 7=�zt�apSa� wtrH
jj e Dp,T-r- GAP ` ,16LD A*j D
Reviewerfluspector Name 7b
Reviewertinspector Signature:
Date: V- L4 tq k ti
I2112103 Continued

Facility Number: ; Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Doespercord keeping need improvement? If yes, check the appropriate box below.
Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did ReviewmAnspector fail to discuss review/mspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
?�. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
[Stocking Form 06W Yield Form [f R infall Inspection After 1" Rain
❑ 120 Minute Inspections [Annual Certification Form
❑ Yes P1Qb
❑ Yes G No
-CfYes ❑ No
ElYes iJ No
❑ Yes 040
❑ Yes 01�o
❑ Yes Q�)eo
❑ Yes ,�o
❑ Yes ld�o
0 Yes ❑ No
❑ Yes E No
❑ Yes [ NNo
❑ Yes [
Ves
o
❑ No
12112103

. t"
Type of Visit O Compliance Inspection O Operation Review 4 Lagoon Evaluation
Reason for Visit O Routine O Complaint X' Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted 0 Certified [3 Conditionally Certified Registered
Farm Name: &4��k
/� M
Owner Name: �` Q1e( /�� S &46, a'O_
Mailing Address:
Time: L-LL-GSLJ
Date Last Operate r Above Threshold -
County:
Phone No:
Facility Contact: Title: /Phone No.
Onsite Representative: G(%f►'F Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
[swine ❑ Poultry ❑ cattle ❑ Horse Latitude 00 4 " Longitude ' 6
Design Current
bwtne Capacity Yo ulanon
❑ Wean to Feeder
F-
Ewpecder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacitv Population Cattle Capacitv Population
❑ Layer FE_-3
Da
❑ Non -Layer Non -Dairy
❑ Other I 1 1
Total Design Capacity
Total SSLW
Subsurface Drains Present IILJ Lagoon Area
No Liu old Waste Management Svstem
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
Itructure 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier: � /
Freeboard (inches):
05103101
v Field Area I
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Yes
❑ No
Structure 6
Continued

.G�,�,f�_.,T«.-1:1-,J�°i-r�`t`'Sr'�'k.:dh�'.�:: "'c. h4�1.i�F �l�-�w.rf+5::n-:y�.F'�_f �.r� �='^=_ �"77,��'•n"�"'"'^+Ja'�+ti+?ti-�=,-"""'!-:r. _ __ ,c. .T_.. of. �_ _ -.- - ..
Type of Visit O Compliance Inspection O Operation Review fd Lagoon Evaluation
Reason for Visit O Routine O Complaint JZ(Foilow up O Emergency Notification O Other ❑ Denied Access
Date of Visit:
Facility Number
0 Permitted 0 Certified 0 Conditionally Certified 13 Registered
Farm Name: �� Aa'q"kmAo�
r /r
� Owner Name: , �n w-, ,&A6Ac A e o
.IF
Mailing Address:
Time:
Date Last Operateo,4kr Above Threshold:
County: a
Phone No:
Facility Contact: Title: Phone No: `
Onsite Representative: W14_C� Integrator: �z I/
Certified Operator: Operator Certification Number:
Location of Farm:
AL
a
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a�" Longitude a 6 "
Design Current
nowme ca aci ra utanon
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
n Farrow to Feeder
Gilts
Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry CapacitV Population Cattle Capacity Population
❑ Layer ❑ Da
❑ Non -La er I JEJ Non -Dairy
❑ Other 1 - -
Total Design Capacity
Total SSLW L
Subsurface Drains Present 11E1LaeoonAren
No Liouid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Lagoon ❑ Sprav 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 theState other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
tructure 1 Structure
cture 2Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): l
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
OYes ❑ No
Structure b
Continued

Facility Number: 51— Date of Inspection,
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered ves, 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 anv stucrures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste ApRlicginn
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 (CANN"MP)?
❑ 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/ RtiP, 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?
(ic/ discharge. freeboard problems. over application)
❑ Yes
❑ No
23.
Did Reviewergnspector fail to discuss review•linspection with on -site representative?
❑ Yes
�No
24.
Does facility require a follow-up -isit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
J© No violations or deficiencies were noted daring this visit You will receive no farther correspondence about this visit '
r r_�c • Y.3$..R .� .. .._� - .. iit��-.-'•«a-:�•w•��'Sr,S :"`rx«,+�i«::n ':'�+.',.��,Y+�.' ^i �.a"• Sy7 '-�nn:?'-°�,`:r"" '.:r.F"ikizrp rL �"`..i.-�. x'.4• .-
Commenis'(refer to q'ttestion �) .Explam:iiny YES saswe3is and/or.any:s�etommendattons ar am_ hitter coinmeMs„� -...�-
Use drawings of facility to better explain situations. (use addtttnmal pages as rtece�ssary) 0 Field Copy ❑ Final Notes
,rye �_ a .
NSPCC r� 4rJ fllQc�c. Y 7o-- 4o�c_C'A'- ea .POC�GrSS Go
�) GU�STE ��-�R✓FU �'pn/q ?�vG,- � � G ` FT��A-T�DnI.
/IIEFOs
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: W1AA03L
05103101 Contdnued

Facility Number: — 3 Date of Inspection /B O
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? El Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12- Crop type
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?
Rea gired 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/ 1-VUP, checklists. design. maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports)
20. is facility not incompliance 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 notif , 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 0 No
❑ Yes ❑ No
XYes ❑ No -
El Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes El No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes El -No
❑ Yes ' ❑ No
❑ Yes ❑ No
❑ Yes -❑ No:
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
El Yes ❑ No
❑ Yes ❑ No
Lo No violations or deficiencies were noted during this visit., You will receive no further correspondence about this visit
'Cotnments{refei-tognes6tin". Ezp]am`aityYESaasweisaa ndlornyretomme€idahonsvr:anyWothercamtmeafs, t
Use drawings of facility to better ezpbtm situations. (use additional pages as n ❑ Field g
r,l _ r eeessary)ti Copy ❑Final Notes
sP C T` o.) CO'1140W ' Yf o 70
��STE P,jo ylvc,_ A-
NFL F�S rC7 �E �D�������. • !/�/� a��1�Fi✓r
Reviewer/InspectorName .� . �,�.:;�:-� _;,=�' .; � - ����~"-�:�,��...��.:„�,�•_�.:�-'�:.�p� ._-�..:�
Reviewer/Inspector Signature: Date: l_
05/03/0/
r
Continued

(Type of Visit JO Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 0 Routine O Complaint Q Follow up $6 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted [3 Certified Q Conditionally Certified [3 Registered
Farm Name: _5ygT�F- ��,r[[ tyJ d
Owner Name: aw;;'4 6L4f C
Mailing Address:
Facility Contact:
Title:
Onsite Representative: f--Q)u=Cj_ 61—A tLo=aAR 0
Time:
Date Last Operated or Above Threshold: _
County: ouQLLo
Phone No:
Phone No:
Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' C " Longitude ' 4 0"
Design Current Design Current Design Current
Swine Capacity Population Poultry CapacitV Population Cattle CapacitV Population
❑ Wean to Feeder ❑ Layer ❑ Da'
Feeder to Finish I I[] Non -Layer I JEJ Non -Dairy
Ej Farrow to Wean —.. _. __..
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Subsurface Drains Present 11L] Lagoon Area
❑ No Liquid Waste
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): /fD
05103101
❑ Yes WrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [--]No
❑ Yes Rj No
❑ Yes PrNo
WfYes ❑ No
Structure 6
Continued

Facility Number: —//�21 Date of Inspection I o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ZNo
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
(!f 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 Pending ❑ 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
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?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
iCommerits'(refer to questiion #� -Explain any YE5 ansKers,and/vr any recommendations or any other comments.
fir
Use,drawutgsaoi�facility�to better.�eieplain tuati6iisz (use' dditional pages as necessary) P" E, ' ❑Field Cony ❑Final Notes
•�$,Pi�7'�fln/ ON�uCY�'� UFC�gus6 � % G-rI ��EgpA2Q /��'�fzC'igrro
�y &mere
All
4, I%�2�nln7,Er1/�� ,�unl� ///i�NnlF� �%� /✓f a
Y0#y Am, ,D9y PO /f 6-< LeoA1 _;�Z,
.S L39
&,
Reviewer/Inspector Name
Reviewer/Inspector Signature: 4&& Date:
05103101 Continued

Facility Number: — Date 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
❑ 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
T�
DER %�vr, s /�� Gov ���r ��►Pz..� ��l�,�evw ��.�r
QdZGk I" ., 4,4 C vS(Qt� /O �r4 �G'/7� ©�: /O�✓EJZo�I�- 1�ND
61YO FF
�jP Sj ON
A.-w-:5
U4
c�,QF� lid/ 7�/� `l�irl li�`,� `7`�tr � /7�/to
�F�,0 /n
'� df , ",J fioln
05103101

Type of Visit QS Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 9f Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
F 10 FacilityNumber bate of Visit: Time:
Not Operational 0 Below Threshold
10 Permitted [3 Certified 0 C�ditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: u County: _PWI­2�
Owner Name: f �/ 1��►'� Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: 4a&&
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 06 " Longitude 0 4 0 K
Design Current
Swine Capacity Po ulatioj
Wean to Feeder
Feeder to Finish iq 0 1
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds I Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I❑ Dair
❑ Non -Layer I 1 10 Nan -Dairy
❑ Other
Total Design Capacity
Total SSLW L
Subsurface Drains Present 1111 Lagoon Area
No Liuuid Waste
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
Spry W94L Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 17 G67
Freeboard (inches): G i4
A I�
❑ Yes
No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes l No
❑ Yes ,I,Q{No
❑ Yes �J No
❑ Yes )ZNo
Structure 6
05103101 Continued

Facility Number: — f Date of Inspection
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?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
Yyes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[/No
Overl ad
11. Is there evidence of over application? Excessive Ponding ❑ PAN Ale
S.rJ�
❑ Yes
I� No
12. Crop type E� llQi¢ �`�PEF2tiJ U'�le5�%3O
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
ONo
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
f
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
ElICJ 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
dNo
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
VNo
23. Did ReviewcOnspector fail to discuss review/inspection with on -site representative?
ElYes
VNo
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
VNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
A.
ComEn"in ts{refer tofi uesbon # Explain any�YES answerssand or any recommendahons_or any�othercamments
a 34' 3 ,'idFia ii sn - ..
Use dramngs of factlity� to eacplam:N ateons: {use�addttianaltp�ages: as necessa ' =
7
Vbetter ary4) Field Copy El Final Notes
.` _ d. S
Olt
Reviewer/Inspector Name %Z .t
Reviewer/Inspector Signature: IVA4LDate: G�
05103101 v� v Continued

Facility Number: Date 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 ❑ 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 ko
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VNO
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 VNo
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
? El31. Do the animals feed storage bins fail to have appropriate coverYes L(J No
m 32. Do the flush tanks lack a submerged fill pipe or a peranent/temporary cover? El Yes /❑ No
lL S 4OXIC-5
Y
7AA-6 CIE
�,��� C.r�z.✓Dow s QPF�.�-
- AC
"5
Ay'o
IV
�P4 ,01 �rr4P
O5103101

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit )0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number - Date or visit:
31 f-_�3
Permitted [3 Certified [3 Conditionally Certified [3 Registered
Farm Name: �Gi1T+t ...............
r
.....................
Owner Name- i h, '0.. �.� �/t a
Facility Contact:
Title:
di Time• f 0 - �
[0—Not Operational Q Below Threshold
Date Last Operated or Above Threshold:...
County- _;PU ! "n
Phone No:
Phone No:
MailingAddress:..................................................................................................................................................................................................................................
Onsite Representative: C G(,w' K l G GHaI r� Integrator:.. s
......................................................................................`�..t:.�..........................I..................
Certified Operator: .......................................... Operator Certification Number :.........................................
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 44 Longitude 0 C�` .4
Design Current Design Current Design Current
Swine Capacity Po ulation Poultry. Ca acity Population Cattle Capacity Population
Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ soars TotaF
SSLW.
Subsurface Drains Present ❑ La oon Area Spray
Field Area
Number of Lagoons ,' ❑
g S p Y
Holden 'Ponds /:Sold Tra s ; No Li uid Waste Management S stem
g p 9 g Y -
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, notifv 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?
01/01/01
❑ Yes IONO
❑ Yes);" No
❑ Yes .�Mo
h �j
❑ Yes XfNo
❑ Yes 11�INo
❑.Yes 2r'No
Continued

Facility Number: 31 — f 13 Date of Inspection l 6 Printed on: 1/9/2001
,5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes )ZfNo
(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 JZ(No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ,21/No
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ YesZdNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes jNo
. 12. Crop type �G �"'1 v 2 ymrI1!/ f _ '
13. Do the receiving crops differ with those d signated in the Certified Animal Waste Management Plan (CAWMP)? [I Yes �No
14. a) Does the facility lack adequate acreage for land application? [IYes�No
b) Does the facility need a wettable acre determination? ❑ Yes ECNO
c) This facility is pended for a wettable acre determination? ❑ YesNo
15. Does the receiving crop need improvement? ❑ Yes ,4"No
16. Is there a lack of adequate waste application equipment? ❑ Yes �No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes,,0'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 ""To
21. Did the facility fail to have a actively certified operator in charge? ❑ YesXNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application) ❑ Yes a
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes)21No
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 ONO
s :o ff• 006ieOcies *... ..... dirr .9'his'visit: Yoh rviii �ee�iye o IPu> th�r , .
eories• otidence. Ao' tf this visit .. .
Comments (refer m question #}: F.itplaen,any YES answers and/or any recommendatiion$ oir'any odd& cosmaeats.
Use dr—swings. of facihty to better explain sikwt k!6s , (use additional: pages as n ecessary) y { x.
S.e� �- �'�P- �►-�. 1;�-f spa- �[ -f d��, .
j
--c ,5-� And t..JA.s-1 e mrw / `� S iS oq v a ►� jG � �� � ,r 1,1,r f 6i fa%`t
Ov�►^a[� p-�cc�;��` avol records �r�e well Iker'.
Reviewer/Inspector Name �� ►� q fT. M_41,S
Reviewer/Inspector Signature: Date: 5100

1~acility Number: 31 —f r 3 Date of Inspection 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 ❑ 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 9No
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:Comments and/orDrawings:
5100

lIhvis><bn of Water Quality
_ O Division of Soil and W_ ate ' Conservation
X 4 S -
-
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit AI.Rouline Q Complaint O Follow up Q Emergency Notification Q Other 0 Denied Access
Facility Number Date of visit: Time: � Printed on: 7/21/2000
O Not Operational Q Below Threshold
[Permitted [3 Certified 13 Conditionally Certified O Registered Date Last Operate Above Threshold: /Farm Name. •.........� .......... ...... County:........... �.............
Owner Name: ................................................... ------------------------------------. Phone No:
Facility Contact:.............................................................................. "Title Phone No:
Mailing Address:
Onsite Representative: „ 1.V 1'� --.-- Integrator:...--_ /�(r .-
Certified Operator ................. .... Operator Certification Numb...
Location of Farm:
Swine []Poultry []Cattle []Horse Latitude C]4 ;4 Longitude • ' 44
Design Current
Swine CaDaclty PODuIatiOn
❑ Wean to Feeder
Weeder to Finish
❑ 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 in Non -Dairy ::J
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lag--n Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact~
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 dischan!e is observed. what is the estimated flow in gal/min?
tf- 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 Structur- 2�+ Structure 3 Structure 4 Structure 5
Identifier. ............ ;?-..S... ....... ................ ...-...................-............-......:..... _......-......._.................-.--..............--....
Freeboard (inches): tiff'-7
5/00 (�
❑ Yes &No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes S�No
❑ Yes I�io
❑ Yes RNo
Structure b
Continued on back

Fa[. lity NuMber: — Date of Inspection p co Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obs rved? (ie/ trees, severe erosion, [] Yes {N0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [kNo
(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 wo
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes I No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level \
elevation markings? ❑ Yes 1N0
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 [f(No
12. Crop type SG
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21- Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
vWhtigris;or• deficiencies -WON_ hated during 4his*visit. - Ypii will-i•eeeiye tW l'ui-ther
�orresporidenee: abatit this visit-' • : • : • : • : • : • .:::: ...
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explaiin situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
❑ Yes XNo
❑ Yes A�4o
❑ Yes �o
❑ Yes J�'Mo
❑ Yes No
❑ Yes No
❑ Yes N0
❑ Yes .9 No
RYes ❑ No
[l Yes No
❑ Yes No
❑ Yes [ZNo
❑ Yes [yNo
❑ Yes J�INo
❑ Yes I)&
Ana s beeri off- ' I "

Facility Number: — Date of Inspection ) ¢j Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or Iagoon fail to discharge Wor below
❑ Yes
ANO,
liquid level of lagoon or storage pond with no agitation?
27. Are then: 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
0
T
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
to
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
CNo
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�rNo
32. Do the gush tanks lack a submerged fill pipe or a peimanent/temporary cover?
11( s
tiona " Comments -an orDrawings:
ALt
5100

Division of Soil and Water Conservation - Operation Review
Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality - Compliance Inspection
13 Other Agency - Operation Review -'
Routine 0 Cum saint 0 Follow-up of DID' ins ection
0 Follow-u of DSWC review 0 Other
EFacility Number 3 � t
Hate of Inspection
.
Time of Inspection ; 'b 24 hr. (hh:mm)
19 Permitted 13 Certified Conditionally Certified [3 Registered
Q Not Operational Date Last Operated: ....................•„••.
``� ��❑
Y..(? M.Jr
Farm Name: ..--•---.........�4?�71.. ...f....Alrlr........................................
County: pt �i..........................................................
........
(........
OwnerName: ....................f h. ...... ....... .[�Y....................................
Phone No:...�����...z-�.�..�'!.��7..................................
Facility Contact: .......................................................... .....Title:...............
rr-• � '`
MailingAddress: ......... �w........ Y....�.[ ...................................
..... Phone No:
28 9 8'
.... .......................WA-x.satiN.C.. ......................... ..•�3.....
Onsite Representative: ............. E(A} . QW.1 '/, . ,5, �
Integrator: 14 ..........
CertifiedOperator: ................................................... .............................................................
Operator Certification Number: ..........................................
Location of Farm:
Latitude • G •1 Longitude ' 6 66
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
�qJ Feeder to Finish ❑ Non -Layer I ILI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish - - •- _ .--: = - Total Design Capacity
❑ Gilts, - -- - -
❑ BoarsE==j Total SSLW
- = _ Number of Lagoons Z Subsurface Drains Present Lagoon Area ©Spray Field Area
'..
Holdrag Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes f;;DNo
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 j 1 No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Doe,, discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [RNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ® Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 5B9,,5S-k SBR-z
Freeboard (inches): .............2�i............. .................
......... ...............................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [S)No
seepage, etc.}
3/23/99 Continued on back

Facility -Number: 31—� 1 Date of Inspection
'�7
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [V 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 Anolication
10.
Are there -any buffers that need maintenance/improvement?
❑ Yes
09 No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
P5 No
12.
Crop type IccYrnuk �Vw �rrvt�l aralr.
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
RNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
[9 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?
(iel 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
P No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
§2 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[;RNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P No
hi'iiYieyerdfr0:N6•yiolatioris'ordefcie'nties•mereiiateddiWingtsyst•64wlieuther .
• . � corres on�ence. a�ot�t this visit. - . - . • • - - - - - - ..... � . � . � .. • .. . - . -
Comments (refer toqueshon #)='E_xplam any YES ergs and/or any recommend:
Use,drawings of faciLty to�better ezplarn situation(use additional pages as necessa
13
lnsvWcret�- 4Soam Eve
re-s�Or\<-N t -} — kkrnL (�
be_ t �\ rrc.cOrk .
I °I • �,r�e bc,t� Glue (s sL�~1% (o� +rt c"e-j L t-cCz e,�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
iy�othercomments'�=..�, �-�,
toe. topxnJ (r, a I •
VA ff L3+W Oft--y*_C&-(JS, .
ac.co►�t� 6 say l � f- .
Date: 1 f 12-a 144
3/2 3/99

Facilit34Number: Date of Inspection 1 L3
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? (Le. 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 permanenthernporary cover?. ❑ Yes ❑ No
Additional Comments 'and/orrawings•
s
3/23/99

Facility Number
© Registered Wertit}ie`d 0 Applied ifor Permit Permitted
Farm Name:........... `i'L�........... ,?.�Mlrl ........ ........................
_
Owner Name: ........................ . h.UJ.11t....... ....... s csKY kayk ........................
Date of inspection '7
Time of Inspection == 24 hr. (hh:mm)
0 Not Operational Date Last Operated: .................
Countv:411
PhoneNo: .....`►�a.3..Z.Z.....................................
Facility Contact:...,,...,..... . Title: .. Phone No:
Mailing Address: ..... -ki,Z.... C x�i .... rS f t........Kt) .:........................... ............(II� .................................. .. $ ......
Onsite Representative:............ ...... Z61AIC A ............................................. Integrator:..... vY.� Q............................................................
Certified Operator:............................................................................................................... Operator Certification(Number:..:......................................
Location of Farm:
O.h........: aOM1'11......is'fr.!� ..... ��..L4�. ......d:.� 3t...klSli,i.�....InIQ ...0.........?71,...11.15n.......................................................................................
------------------------------------------------------- ...
Latitude Longitude 0• �' 0"
Design a .Current Design Current Design . , Current
Lis`F�Swine h ' rc.. Capacity Population y' Poultry Capacity , p6pulation Cattle Y x Capacity; Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. -Are there any buffers that need maintenancelimprovement? ❑ Yes V9 No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in ,aUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [A No
❑ Yes ® No
❑ Yes [25 No
l�
❑ Yes No
❑ Yes J�t No
❑ Yes KNo
❑ Yes ® No
%Yes 01 No
❑ Yes 10 No
Continued on back

Facility Number: —k 3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 0 No
Structures f1-agoon0folding Ponds, Flush Pits, etc)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Stricture 1 Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 2-
......................................................................................................................................................... ........................
Freeboard.(ft): ........... Z :.S.....
............................................................................................................................................................. ........I......................
10. Is seepage observed from any of the structures" D Yes [3No
11. Is erosion, or anv oilier threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) a
ti
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess_ of WMP, or runoff entering waters of the State. notifv DWQ)
15. Crop type ............. 6y-b)VI..................................S.CrAI �.........CvY-0ti.l!a........ ....... .-.............................
15. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
ti
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a tack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations or deficiencies were noted• during this: visit..You.will receive no further
correspondence about this.
X- Yes
(] No
4 Yes
❑ No
❑ Yes
No
❑ Yes
No
Yes
i1fo
❑ Yes
No
Yes
❑ No
❑ Yes
No
Yes
❑ No
Yes
[XVO
Yes
❑ No
❑ Yes EANo
❑ Yes 1P No
❑ Yes 1P No
Continents (refer`to uestion*): -Ex lain'an YES answers and/or any recommendations organ , other a©contents s:
q. P Y Y
r
Use drawings dia,cility to better explain situations. (use additional pages as necessarv} 4 S
t
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6W,
7/25/97
Reviewer/Inspector Name
L
Reviewer/InspectorSignature: _ ��� Date: IVQ

® Division of Soil and Water Conservation ❑ Other Agency
❑ Division of Water Quality
10 Routine 0 Com laint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 12/9/97
Facility Number 31 113
Time of Inspection 1530 24 hr. (hh:mm)
O Registered MCertified [3 Applied for Permit SPermitted 0 Not Operational Date Last Operated:
Farm Name: S9utk.BKapwh.JFr�ta�................................................................................... County: D?uPlin............................................... WDRQ.........
Owner Name: EflwjxL..................................... Blumbard .................................................. Phone No: 21.0: 293. 4727..........................................................
Facility Contact: Edwin.Alatt.d CID ......................................... Title:.�EY11 C:.::... ........................................ Phone No:
Mailing Address: 3.Q6Xh;u'.Ik.ErciDcrickjW............................................................... W..arsaft:..NC.......................................................... 28398 .............
Onsitc Representative: Bdnatx.Bl nc)xard...................................................................... Integrator: Mujwby.l<.amily..Eaj'=.....................................
Certified Operator:,Et1wItO................................. Hlaachard................: ..... Operator Certification Number:. 18.002..................... ................. ........
Location'of Farm:
Latitude 34 " 57 ' 07 Longitude 78 " Ob 09
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes M No
2. Is any discharge observed from any part of the operation?
❑ Yes
M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
© No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
© No
c. If discharge is observed, what is the estimated flow in ;gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
© No
3. Is there evidence of past discharge from any part of the operation? -
❑ Yes
M No
4. Were there any adverse impacts to the waters of the State other than from'a discharge?
❑ Yes
M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
M No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect -at,,-the time of design?
❑ Yes
M No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
M No
7/25/97

Facility Number: 3T 113
8. Are there Iagoons or storage ponds on site which need to be properly closed? ❑ Yes N No
Structures (LaQoons=IloldinL, Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? " ❑ Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ............... g1d ............... ..............I3IM..............
Freeboard(ft):............. 3.,1.7.............. ...8.25............. ........I.... ........................................................
...................................
10.
Is seepage observed from any of the structures?
❑ Yes
CO No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
N No
12.
Do any of the structures need maintenanceCimprovement?
❑ Yes
N No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
N No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
N No
(If in excess of WNT, or runoff entering waters of the State, notify D WQ)'w
15.
Crop type ..........................RyY......................... ............................... .......................................................................................... ....................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
N No
17.
Does the facility have a lack of adequate acreage for land application?-
© Yes
N No
18.
Does the receiving crop need improvement?
N Yes
© No
19.
Is there a lack of available waste application equipment?
❑ Yes
N No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
22.
Does record keeping need improvement?
N Yes
El No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ® Yes © No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes N No
L •No. violatims: mrdeflcieifdes• were-rioted-dur-ihi; tiliS •visit: I'O�i •Vui1i: receive "t;b t>Irther. :
.:carres�ondenc� aL�ouf th�s.vis.it+ ... :: .. .. .
18) New fields being established. Also has had trouble with original rye & has replanted:
22) Need waste sample within 60 days of irrigation.
24) Need copy of design for original lagoon & certifications.
to fill out emergency action plan. Should have odor, insect, and mortality, checklists filled out by T.S.
should investigate lift station to be sure that it is not leaking.
7/25/97
Reviewertinspector Name oha + goal
Reviewer/Inspector Signature: Date:
A6

�
,Cs ,�' i. _. v.4.. ... wi:.i�.,+'JiL�. - '..�.E4i. ... .z�: ,....__ __..-:.; .. ':.� ._:� •...,.+ak. t'. C. ,_ ,. ..�-.--•:-.-.., . ---.r --_ _.—. c,c.. a R.>ra %h :� t A.
C
DSWC Animal Feedlot Operation Review
® rt
DWQ Animal Feedlot Operation Site Inspection
*
® Routine 0 Complaint 0 Follow-u of DWQ ins ection 0 Follow-u of DSNVC review 0 Other
Fac�Nber3
��
Date of Inspection 9
Time of Inspection kid 24 hr. (hh:mm)
Total Time in fraction of hours
Farm Status: Registered ❑ Applied for Permit
(ex. L25 for I hr l; min)) Spent on Review . 5
❑ Certified Permitted
or Inspection (includes travel and processing)
113 Not Operational I Date Last Operated: ..........................................................................................................................
. ....................
Farm Name:..... S. o..�l. ...... E. rvt ^ A\.. .....�"' "Y\.
_. County: ....b.u..? t.t..r .............................
Owner Name:........��.� w.f.."1�..................................
Phone `o:..�.9.1..4..�... z.q..�.` ..�.1. Z.. �......................
Facility Cotatact: ............................. ... Title'
Phone No:
Mailing Address: ....,�.!�.�2........ � ko.'.�.1..�.,-......F.Y...�c�R�.�.s.,.�:...�
•......�J1}.sSrY��..tX.� sty...l`..r..C- ........................ ..� .$..4Z..q.�.
Onsite Representative:...—'&..t..t..tt ....................................... Integrator:.... :Gt.,r.....................................................
Certified Operator .................................................... .......................................................
.... .........................
... Operator Certification Number:...,,�,��
:,ocation or rarm: s
o.....V:u.�o� .....s.►.......o ..... .R.1.1.i.3..7......a.�.�,..,r�.atr i..m.� .. jo..z.S...►�,i.... ......,
> r. .G .oy,.,....w.t.. .....,5.IZ.!.1..g.`..................... ............................................................. ............ ................... ............................... I .........
.......
Latitude • S ' ©�� Longitude o i < «
Type of Operation' Design Current Design Current Design Currenf
Swore, Capacity Population Poultry Capacity- Population Cattle Capacity Population
❑ Wean to Feeder
eederto Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non Dairy
Total Design -Capacity
TotaISSLW.l 57792
f La oans:`I Holding Ponds 5uhsurface Drains Present g Lagoon Area
,
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
Spray Field Area
❑ Yes 91 No
❑ Yes 8 No
❑ Yes ® No
❑ Yes jR No
1A
❑ Yes KNo
❑ Yes 91 No
❑ Yes 9 No
❑ Yes C9 No
Continued on back

Facility Number: y -
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4
z.....z.5................ ........ ........ $................. ...................................... ................................
10" Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
[RNo
❑ Yes
® No
❑ Yes
®.No
❑ Yes
&No
Structure 5
Structure 6
.............................................................
❑ Yes
®..No
❑ Yes
8[No
Yes
❑ No
❑ Yes
PS No
❑ Yes
® No
15. Crop type .....:'�1t.has.................. ...�vuk�.!..r�.,r�.................. ................. ...................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss.review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes KNo
❑ Yes allo
aYes ❑ No
❑ Yes B No
❑ Yes ® No
❑ Yes R No
❑ Yes B No
29 Yes ❑ No
RYes ❑ No
12 4 .a ¢ t l o � f L acy a 0 n S1 V--d ,) Lk 1a.4 �`Q y E w % �_ i w+ ..-• eCr a e Q.
t $ . yJ e r G y'l Corr ert [ �J L�}, q-S.d 3 -� b �Y ✓.-.. VV GCS.
Z 3. A t G o -4 , e- �, 0 +''C�- �' � G 'r W CL S $ p 1
G
ct d�-a ti i •s o n t � � e.r-a. t-a r t t �,r a. � , •—y b � r--.�-.�.� d--a_ `ri �--3 �. t a- �
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k-a a r V\-o { D o. r t p a.+1 u w QM O✓r-p 4'��-t C a ��
Reviewer/Inspector Name
Reviewer/Inspector Signature:
cc: Division of Water Oualirv. Water Oualuv Section. Facility Assessment
Date:
4/30/97

Facilityc of Inspection:
-7 Number Date n
,Additio"n"a',C-6ii�ents.andlo'-D s
'3 Ax5tj v- V" IOU lc-;
��L 'ye-t Y-V-lv-, W c '..
C�l C� a -I
:�� I V.
a -.I f-e So I I
co -t- c,-t,
i ie cy-
A t0c 4—i te— o
Lx, t
4/30/97

iel bo 'b© oo:o0
-
023 P02
Site Requires Immediate Attention: N()_
Pattility No.
ATVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLAT OPERATIONS STTE VISITATION RECORD
DATE: , i99S
Time:
Faun r
-mainp
county
Integral
on site
Physics
Type of Operation: Swine _x- Poultry — Cattle
Design Capacity:
DEM Certification Number:
Latitude: 34 " Ste' ' j&«
Number of Animals on Site:
ACE, DEM Certification Number: ACNEW
longitude:. e ° C4.',aZ'
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Fretboard:t' o2--Ft. ^Inches
Was any seepage observed from the lagoon(s)? Yes or No was any erosion observed? Yes or No (Seepage Was
Is Adequate_ land available for spray? Yes or No Is the cover crop adequate? Yes or No Not Evaluated)
Cg-,) being utilized: KSpray Field or cover cro was not evaluated
Dc,.. the facility meet SCS minimum setback criteria? 200 Feet from Dwellin '► r No
100 Feet from Wells? or No '
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes of No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Lane: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, orather
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yeas or No(Waste management records Were not
Additional Comments:_ - _ reviewed)
very h ict on a i4org —thorouxb-inspection wilL be conducted Ui the fiiture.
Please contact-MEM should any .condition arise that-poBes a danger to surface. waters.
* This farm was not located on, a USGS TOPO map to determine x'Blue Line' status.
if ou heve questions concerning this report glease do not hesitate to,contact the inspector
at [phone]. please contact the inspector if the above information is incorrect.
Inspector Name
Pacwty Assessment Unit
?C2:
Signature
Use Attachments if Needed.