310123_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

■l
iype of visit: Uompiiance inspection U uperation Review U atructure Evaluation U Iechnical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 2q Arrival Time: Z O Departure Time: County: ,c Region: ►'Vl�
Farm Name: _ {� k 1 jla _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �,..� l Title:
Onsite Representative: 1
Certified Operator:
Back-up Operator:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C►urrent
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
11 INon-Layer I
Dairy Calf
Dair
y Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
5U52
mDesian Current
l Ca aci P.o
rNon-Layer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
s
Beef Feeder
Boars
Beef Brood Cow
the r
Other
Turke s
TurkeyPoults
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 19 No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
[:]Yes [ No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facility Number: jDate of inspection: I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A 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): ZZ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes k% No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �< No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes 2f No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes gNo
❑ 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 �5 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 4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes IRT 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 X No
18. Is there a lack of properly operating waste application equipment? ❑ Yes �!o No
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J�SNo
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes [:]No
the appropriate �box.
. LWUP ❑ Checklists)� Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. N Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard Waste Analysis "Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NTo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA
❑NE
❑ NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Fatili Number: 31 - 2-3 jDate of Inspection: I ( 1 241
1 r?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IV -No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
N No
D NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
fN NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 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 X No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ['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 15No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
@,4nes - No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [g No
❑ NA
❑ NE
Comments (refer to.;question #) Explain any YES•answers:,andlor.any-additional recommendations or°any other comments
Use draw►ngs'offacility toalietterkeacplsun situations"(use additionai:pages:as neceWssa _
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Reviewer/Inspector Name:
' CD -- 4 _--emu
� �S� 1R. 1 " �i ��Z
Reviewer/Inspector Signature:
Page 3 of 3
Lo 'taj E, %��
Cad �
evf
crn Z5
Phone: 11t1 ` l"l (R — 7 3 f
Date: I 4[.?1Ci 01 S

L7
Type of Visit: t`JComp a Inspection U �;01=10W-up
Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t % ip Arrival Time: j o Departure Time: L2J County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
n ��
Onsite Representative: (<'` % q�n /-/, .I
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wqan to Feeder
I
iNon-Layer I
Dairy Calf
feeder to Finish
Farrow to Wean
Farrow to Feeder
7 4
94
Design C►urrent
D F P,oult., Ca a�i- P'a .
Dairy Heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Qther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Dyes
6No
❑ NA
[_]NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Z_3 jDate of Inspection : /7
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? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes YJ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No [] NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes <o ❑ 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 [.iQo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes EfN0 ❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [ Na ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes rNo❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �❑ 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 ❑ 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: -
2l . Does record keeping need improvement? If yes, check the appropriate box below.
Yes ❑ No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste 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 QTo NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes To NA
[] NE
Page 2 of 3
21412015 Continued

Facili Number: - Z Date of Inspection: f �7
�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 [2,Tqo' ^❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NAA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ '1VA ❑ 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 No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes [ K ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes [6No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question,ft Explaiwany YES answers and/or any additi6nal recommendations or
u necessa ry}
any other.c"o=' mments.:__
Use drawings of facility, to better x lamasivatRons (use,additional:p ges as �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
(� C, 'O -- 1
4( N Vo --f
Phone: +0 7S,7
Date:
2412015

Type of Visit: 0 Com ance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /Y Arrival Time: 339 Departure Time: t(Qp County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: t /� r y �c►T /� t
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: �� D
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Pointry
La er
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . POultr,
Layers
Design Current
Ca aci. P■o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
F-TO—ther
Turke s
Turke 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 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 [ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [::]No
[:]Yes 9N�o
ElYes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412015 Continued

Facility Number: aD IDate of Ins ection: 1 Z /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
7 No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NQ ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 1' ❑ 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 Vj No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA 0 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 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ YesgjNo ❑ 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 ❑ NA E 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 E-NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 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 0 No ❑ NA
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA5�NE
Page 2 of 3 21412015 Continued

Facili Number: - 23 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA rNE
� J
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA
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 rNA
NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 7No
�' ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ZNE
❑ Yes
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
❑ No
❑ NA
E 1
�'❑rj�40
NA
❑ NE
❑ NA
❑ NE
o [] NA ❑ NE
Comments (refer to queWon #) Explain any YES answgers_and/or any:additional recommendations•or-any other comments:: ;m
Use drawings of facility ta.better explain s tuaiions.(use„additiotal pages as'necessary)..
514, ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
vu. Vt �o �C
Phone: 0 IO 7 ? 6 ?�Py
Date: tZ43J ,- 6
21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: County:
Farm Name: eaOwner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: JC4_292
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator: IL4 �5
Certification Number:
Certification Number:
Latitude: Longitude:
Region:
Design Current
Swine C►apacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
C►apaeity
Current
Pop.
Design Current
Cattle Capacity Pop.
D2ja Cow
Wean to Feeder
Non -La er
Da'a Calf
�C
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other I
Dry P,oultr.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design
Ca aci_
Current
Pao
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees 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 ,EfNo ❑ NA ❑ NE
❑ Yes �jNo
[—]Yes ZfNo
[:]Yes No
❑ Yes No
❑ Yes PNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ONE
Page 1 of 3 21412014 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4.•Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'EQ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ,0No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �T
5. Are there any immediate threats to the integrity of any of the structures observed?
J3 Yes ❑ No
❑ NA
❑ N E
(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 Fe] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes 'o No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Er 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 0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �jNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes J:;4 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 El No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes „Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 2TNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes"P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes .0No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes D No
[:]NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ZONo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes X1 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - 123 I Date of Inspection: 3I
24. Did the facility fail to calibrate waste application equipment as required by the permit? zrYes ga No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes _[:�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo D. 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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes P-No ❑ NA ❑ NE
[:]Yes ETNo ❑ NA ❑ NE
❑ Yes P'No ❑ NA ❑ NE
[:]Yes -No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [::]Yes [�'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E]'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes allo ❑ NA ❑ NE
Comments; (refer, to question ft Explain any YES answers andlor'any additional reeommendationi;or any, other com,ments:a:. fit:
Use drawings of facility to better explain situati/onns (use additional pages asJ necessary).
CVOLAAd 06cuyl (A)
` no�-ods 1,1 s
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
miff W - I
4:6-
/1k Ae<� aocvzle o 0r_1'-4jeC4_
Phone: c
Date: T ��
214,17014

Type of Visit: C
Reason for Visit:
Date of Visit: L
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
e Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Arrival Time: Departure Time: County: Region:%
Facility Contact: Title:
Onsite Representative: �" /L.� �,[�f { r� o✓�
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop,
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
]Non
-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D.t. P,oult . C•_a aci _ P.o
ILayers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
r El
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes L'No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [�fNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
C2 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
ONo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: jDate of inspection: ZZV
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o
• a. If yes, is waste level into the structural freeboard? ❑ Yes [j f4o
Structure I
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4
Observed Freeboard (in): 2
5. Are there any immediate threats totheintegrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑NA ❑NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes PNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �fo ❑ NA ❑ NE
waste management or closure plan? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes _No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes �io ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Jallo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes L�t'&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 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 E:rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes J2+No ❑ NA ❑ NE
[] Yes ONo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other-
2 1. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes �TNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑' No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214120I4 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes P'No
25. Is,the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes eNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes ,❑ No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes ;;J-No ❑ NA ❑ NE
[:]Yes eNo ❑ NA ❑ NE
❑ Yes J:�+No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes P�'No [] NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes [ j No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 21"No ❑ NA ❑ NE
Comments (refer to question.#): Explain:any YES answers and/or any additional recommendations or;any°othercomments.
Use drawings of facility to better explain situations (use additional"pages as necessary' ): ..
6I r 1 y 0-0-7 No
1l/z1/3 04'9�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: `l /
2 4/201

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facilty Number. 310123 Facility Status:
Inppectlon Type: Compliance Inspection
permit: AWS310123 ❑ Denied Access
Inactive Or Closed Date:
Reason for Visit: Routine County:
Duplin Region: Wilmington
Date of Visit: 11/13/2014 Entry Time: 11:30 am Exit Time: 12:00 pm Incident #
Farm Name: Rosa Farm
Owner Email:
Owner. James Kenneth Barnhill Jr
Phone: [phone]
Mailing Address: 3442 N Folic Or
Conway SC 29526
Physical Address: 332-A Cantown Rd
Rose Hill NC 28458
Facility Status: ❑ Compliant ❑ Not Compliant Integrator.
Location of Farm: Latitude:
34° 50' 34" Longitude: 77° 55' 17"
East of Greenevers. Entrance is 0.1 mile on right before the end of Carr Town Dr. Carr Town Dr. is on the North side of SR 1953
approx. 3.5 miles East of Hwy. 50. Farm is visible at the forte in path.
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat
Waste Application
Records and Documents Other Issues
Certified Operator: Operator Certification Number.
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name James Peterson Phone:
Primary Inspector. Kevin RaWand Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
NO PIGS. NO LONGER WITH MURPHY BROWN.
page: 1

' . Permit: AWS310123 Owner -Facility : James Kenneth Bamhil Facility Number: 310123
Inspection Date: 11/13/14 ' Inssection Type: Compliance Inspection Reason for Visit: Routine
Waste Structures
Dlalgnated Obse^red
Type Identifier Closed Date start Date Freeboard Freebwrd
Lagoon 1 19.50
page: 2

Permit: AWS310123 Owner - Facility : James Kenneth Bamhii Facility Number: 310123
Inspection Date: 11/13/14 Inpsection Type: , Compliance Inspection Reason for Visit: Routine
01schames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at:
Structure
Application Field
Other
a. Was conveyance man-made?
b. Did 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,.notiiy 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 Waters of the
State other than from a discharge?
Waste Collection, Storaee $ Treatment
4. Is storage capacity less than adequate?
If yes, is waste level into structural freeboard?
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed and/or managed through a
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit? (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
maintenance or improvement?
Waste Application
10. Are there any required buffers,. setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect application?
If yes, check the appropriate box below.
Excessive Ponding?
Hydraulic Overload?
Frozen Ground?
Heavy metals (Cu, Zn, etc)?
PAN?
11319-1:Mt:ly"MMIT-Wj
Total Phosphorus?
Failure to incorporate manurelsludge into bare soil?
Outside of acceptable crop window?
Evidence of wind drift?
Application outside of application area?
Yes No Na me
❑ M ❑ ❑
❑■❑❑
❑ M ❑ ❑
❑■❑❑
Yes No Na No
❑■❑❑
❑■❑❑
❑
M ❑
❑
❑
M ❑
❑
❑■❑❑
❑■❑❑
Yes No Na No
❑■❑❑
❑
❑
❑
page: 3

. Permit: AWS310123 Owner - Facility: ,lames Kenneth Bamhil Facility Number. 310123
Inspection Date: 11/13/14 Inppection Type: Compliance Inspection Reason for Visit: Routine
Waste Application
Yes
No No He
Crop Type i
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
■ ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
❑
❑
18. Is there a lack of property operating waste application equipment?
❑
❑
❑
Records and Documents
Yoe
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑ ❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑ ❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
❑ ❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

. Permit: AWS310123 Owner - Facility : James Kenneth Barnhil Facility Number.
310123
Inspection Date: 11/13/14 Inppection Type: Compliance Inspection Reason for Visit:
Routine
Records and Documents
Yes
No No No
Crop yields?
❑
120 Minute inspections?
[]
Monthly and V Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?'
❑
E ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
0 ❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑N
❑
❑
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?
❑
0 ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
1101111
Other issues
Yes
No Na He
28. Did the facility fail to properly dispose of dead animals within 24 hours andlor document
❑
N ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑N
❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0011
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
1101111
CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
❑
❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
N ❑
❑
page: 5

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: CH11(outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
rrival Time: n6 eparture Time: County:
f
Region: f
Farm Name:
1!t
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I_ Title:
Onsite Representative: <�G�/y'OS Cl � ��id )'7
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
rFeeder
Design Current Design Current
Capacityp. Wet Poultry Can to Finish La er
an to Feeder Non -La er
Design Current
Dai Cow
D ' Calf
Dairy Heifer
to Finish
Farrow to Wean Design Current
Farrow to Feeder D . P,o�ltr. Ca aci_ P,o ,
Farrow to Finish Layers
Dg Cow
Non-Dai
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ON. ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes 'No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? T�
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
Z. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 'XNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214,12011 Continued
J

Facili Number: jDate of Inspection:
,3 /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Ye� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ONo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any irmediate threats to the integrity of any of the structures observed?
❑ Yes �o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes o ❑ NA ❑ NE
waste management or closure plan? TT
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 FJ o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesEl"No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ffNo
❑ 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 � /�To
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 1 '%
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes J1 o
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes LD%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 o
❑ 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 ,EfrNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes .E No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - 2 Date of inspection:
�24. Did the facility fail to calibrate waste application equipment as required by the pe t? ❑ YesNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes l jNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
❑ Yeso
❑ Yes E3,No
❑ Yes�o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
J2�
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
;,No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
T[:jNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
`. ��--
1�
016
3 2t�141�Z
�.4
z,7
7 3 P5 3
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 214;011

Type of Visit: " 'Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: t-21 ze�
Certification Number:
Certification Number:
Longitude:
Wean to Finish
Design IfIffr]
DesignWet Poultry Capacity Pop.
La er
Cattle Capacity Pop.
Da Cow
Wean to FeederNon-La
er
Da' Calf
Feeder to Finish
Il . P,oultr. Ca aci P.o
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes.",0 No [] NA ❑ NE
❑ Yes
ko
❑ NA
❑ NE
[] Yes
ZNo
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes )E No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes VNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection: 1-2-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
VT No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: _L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ 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
ZfNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Z 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
0 NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
;ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
C] Yes
j:]-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Jallo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
;214o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
qNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
2fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
WNo
❑ 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 ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IiNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: bate 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 TefNo ❑ 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 �TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes F]No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes L-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 EfNo ❑ 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 rjj' No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
h
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �2 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 ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ZrNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes n/No ❑ NA ❑ NE
Comments (refer to question f: Explain any YES answers and/or any additional recommendations or any other comments...
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
S s j
a 1 y
L/ 6/"-
i� d S
Phone:
Date: /dP— IJ7113
21412411

(Type of Visit: 90compliance Inspection O Operation Review p Structure Evaluation O Technical tssistance 1
Reason for Visit: Routine O Complaint O Follow-up O Referral O Ememencv O Other 0 Denied Access I
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: re er-t r,✓L Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: p �lsdY1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
La er
Wet Poultry Capacity Pop.r,,]]",
Cattle
Da' Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Design Current
D , P.oult 1 Ca a_c_i_ P,00n-Dal
Layers
a' Heifer
Cow
ry
eef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
eef Brood Cow
Other
Other
Turkeys
outts
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?
❑ Yes P'ON'o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes 2fNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes KNo
o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: Ds ection: ZZ
Waste Colloction & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No
a. If yes, is waste level into the structural freeboard? ❑ Yes �ErNo
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
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?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [;/f4o ❑ NA ❑ NE
❑ Yes p< ❑ 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
PNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�Ko
❑ 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
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
C No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes P No
❑ Yes ';Xo
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
❑ Yes Ey No ❑ NA ❑ NE
❑ Yes ,[No ❑ NA ❑ NE
❑ Yes Ca"N'o ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? [:]Yes elNo ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: /
24. Did4he facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FNo ❑ 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 zNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZfNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0No ❑ 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 E�`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 tNo ❑ 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"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 ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes R�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2/No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments�s, ,,
Use4rawings of facility to better explain situations (use additional pages as necessary).
00W V,
oIg
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
U
C
Phone: d"
Date:
21412 kl

❑ Farrow to Feeder
❑ Layers
❑ Farrow to Finish
❑Gilts
ElNon-Layers
El Boars
El
Other
❑ Turkeys
❑ Turkey Poults
❑ Other
; ❑ 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?
d
��tv�sion of Water Quality ;
FaClltty�Number- QDtvision of Soil and Water Conservation
��Othet Agency ," m
�r
Type of Visit $compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QORoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,LLB Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
3
Facility Contact: Title:
On site Representative: - L' ly-5— 604,11010-7
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No: M.,
Integrator:_
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' Longitude: = ° = ' 0 «
- Current - ,
Swine Capatty _P.o ulattan Wet Po Design 'Current Desi n t,
�p ultry ,Capacity Population Ca
❑ Wean to Finish ❑ Layer El)
❑ Wean to Feeder3-10 Non -Layer ^ ❑ r
' ❑ Feeder to Finish" ; ❑ I
❑ Farrow to Wean Dry Poultry ❑ f
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood
.w
Number�o#�
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?
Cy ow
Cy alf
Hy eifer
Cow
❑ Yes j2rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
El NA
❑ NE
El yes
WNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection !r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA ❑ NE
JFe
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No
❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes PNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes g(No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes o
El ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes XNo
El NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
ElNA ElNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes V N
El NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes No
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
ElNA ❑ 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 ZNO
❑ 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 reviewlinspection with an on -site representative?
❑ Yes
❑ NA ElNE
33. Does facility require a follow-up visit by same agency?
ElYes VNo
❑ NA ❑ NE
Additional Comments and/or Drawings:
A P-_/
LI-A0 cv'"'Is
Page 3 of 3 12,128104

Facility Number: — Z3 I Date of Inspection
1 Waste Collection & Treatment
eNo
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?
❑ 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 ;2�4o
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes )YNo
El NA El NE
through a waste management or closure plan?
///
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes '�INo
❑ 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 [:Ko
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ YesZf�'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or I 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
,�+
El Yes �J No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ) 2'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 9-No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes JeNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [--]Yes �3/No ❑ NA ❑ NE
Comments (refer to questio&#)Explain any YES answers and/or any recommendations or any other comments :b
Use drawings of facility to better expl_"atn situations use additional'pages as necessary):
Reviewer/Inspector Name — Phone: 7 %
Reviewer/Inspector Signature: Date: /Z
Page 2 of 3 12128/04 Continued

Type of Visit ocompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visitleloutine O Complaint O follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: La
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: �U Departure Time: County:
Facility Contact: Title:
Onsite Representative: 4klS
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: W1�
Location of Farm: Latitude: [= u = d = Longitude: = ° = 6 0
dt
Design Current
Design C*urrent
NUNN
Design Current
Swine Capacityty Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Laver
❑ DairyCow
❑ Wean to Feeder
10
Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Daia Heifer
❑ Farrow to Wean
Dr`y Poultry
❑ Da Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
Non -La ersElBeef
Feeder
E Boars
❑ Pullets
❑ Turkeys
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Pouets
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
;3"No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
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)
❑Yes
ONo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
All
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
�No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection
rite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ 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): XIL
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7No ❑ NA ❑ NE
$. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JZI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
V(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
El NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
i No
❑ NA
❑ NE
Reviewer/Inspector Name E. Phone: (/- -
Reviewer/Inspector Signature: Date:
Pavo 7 of 3 12/2R/114 (antinurd

Facility Number: Date of inspection r
Ra: uired 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 El NE
the appropirate box. El �p ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;io ❑ 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
J2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RINo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;6No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
oNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
)6No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PfNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
10 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
10 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EfNo
❑ NA
❑ NE
Addrhanal:.Comments,:andlor Drawin s
AL
-3/L g "
/0 9/0 -7
Page 3 of 3 12/28/04

Division of Water Quality
Facility Number 4 JZ Q Division of Soil and Water Conservation
- - - Q Other Agency
Type of Visit XCompliance Inspection 0 Operation Review 0 Structure Evaluation '0 Technical Assistance
Reason for Visit JXRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: t eparture Time: �ounty: 4VW Region: 91;leV
Farm Name: —/7�5�^-Owner Email:
Owner Name: hM_ S �7�l1Sa� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: S Ank_Z-6o"l Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: --] o 1= E=1 « Longitude: 0 e
Design„ ,Current Design Current Design Current
Swine Capacity' Population Wet Poultry Capacity Population Cattle Capacity Population
'=
'
❑ Wean to Finish
❑ Layer
El Wean to Feeder
I ILI Non -Layer
Feeder to Finish
00El
T T
Dry. Poultry
Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Farrow to Finish
❑ Non -Layers
El Gilts
❑ Pullets
❑Boars
-- ---.
- _
- --
n TnrkPvc
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
ler ❑ TurkeyPoints
Other ❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
M
❑ Yes 0No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0 No ElNA ClNE
❑ Yes ANo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
12128104 Continued

Facility' Number: — Date of Inspection lY/�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes '0 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: IV
Spillway?: 0
Designed Freeboard (in):
Observed Freeboard (in): 3
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ElNA ❑ 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? 'WYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(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 VfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes '0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Win w ❑ Evidence of/1Wind Drift ❑ Application Outside of Area
12. Crop type(s) AF
13. Soil type(s) l62A)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes X No ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? ElYes XNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Jff No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes XNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes VfNo ❑ 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)::
r
04 61_-Q 1y- u p 1- 60' . �D•�E f �aN _2r�,c,-oq �5 S C�o�76iD /vim
Reviewer/Inspector Name �Qoye Phone: ( 0
Reviewer/Inspector Signature: ¢,� ,./ Date: q p
Page 2 of 3 12128104 Continued

Facility Number: 13— f Date of Inspection
Required Records & Documents VNo
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes ❑ 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
10
❑ Yes No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes ,E No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 31No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes '0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 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?
❑ YesNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
/
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional .Comments and/or Drawings:
Gvt�� o�►reo� /1/�b �o i.�s�,�� G• oo,✓ ��, ,P,gs.
�,,..� �,,�� /�o�. l7<o a►sEs. Du�.eJ f'2 f�%fs
ff� 170� �uSrES
Page 3 of 3 12128104

31 M. la3
Type of Visit Co fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: o Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: J 14 �E�C�L�nN
Certified Operator:
Back-up Operator:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: a 6 = 6 = H Longitude: = o = A
Wean to Finish
ILJ Layer I
10 Non-Layet I
I
LI Dairy Cow
Wean to Feeder
❑ Dairy Calf
Feeder to Finish
3 7 ��
Dry Poultry
❑ Dairy Heifei
[I Dry Cow
❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Beef Stocker
FffNWo-La rs
Gilts
Beef Feeder
Boars
❑ Beef Brood (
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?
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
❑ N ❑ NA
❑ NE
❑ Yes
❑ Yes
o ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: -- a3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:06-00^1r
Spillway?:
a
Designed Freeboard (in): % 6, ,-
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [T0 ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes 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 environmentalth
Eleat, 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 JZNo ❑ 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 PTo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EI 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 > 1Q% or l0 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) I J E 2YO V BOA C``,G) 560
13. Soil type(s) LAM
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑,Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ✓O NNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes L�'no ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes P'No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes &4o ❑ NA ❑ NE
�xYark KEEL Can of SIyP6�E CALA(9x.�r�' t� R -6
OAPVC PUP PIv Afi'p rA 6
Reviewer/InspectorName ��(!, Phone:­CJ
Reviewer/Inspector Signature: Date: )t Lo5'
f�Mnin� � a

FaSility.Number: — Date of Inspection !]
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes NA ❑ NE
• 20. Does the facility fail to ha=11onents of the CAW readily available? If yes, check es❑ No ❑ NA ❑ NE
the appropirate box. Checklists Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1Vo ❑ 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 Ej Nc ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ;�
25. Did the facility fail to conduct a sludge survey as required by the permit? El ❑ No NA XNE
26. Did the facility fail to have an actively certified operator in charge? El Yes o ❑ 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
Ek o
❑ 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
pia
❑ 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
ErNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
A°dd>ttoival Comenfs and/or Drawings r k 5" 4t gY�i w
12128104

Type of Visit j2rCompiiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ._(>,Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: .% Tune:
O Not Operational O Be]
13 Permitted U Cer Meed 13 Conditionally Certified 13 Registered Date- Last Operated or Abov Threshold:
VIn
Farm Name: �,.��QQ ko_Cn3 County: _.
Owner Name: . _ _ Phone No: ._
-Mailing Address:
Facility Contact: . ____w_ _ _ ----Title: __ Phone No: w
OnsiteRepresentative- i �. CSCIntegrator. �&r _.
Certified Operator: _ .. _ , _. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 4;4: Longitude ° 64
Dis' charges & Stream imAacts
1. Is any discharge observed from any part of the operation? ❑ Yes ,,13No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes .E3Vo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )ago
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;>er'
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: _ . /�j _ _ _ _ -
[
Freeboard (inches): j U
12112103
Continued

Facility Number: Date of Inspection C,
S.*'Are there any immediate threats to the integrity of any of the structures 4ved? (ie/ trees, severe erosion, ❑ Yes '2VO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes .E No
8. Does any part of the waste management system other than waste structures require maintenance!improvement? ❑ Yes .EJ-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes p3xo
elevation markings?
Waste .application
14. Are there any buffers that need maintenance/improvement? ❑ Yes -E3-No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes T No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper or Zinc
12. Crop type 3z2zp'�//�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ENO
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 E No
16. Is there a lack of adequate waste application equipment? ❑ Yes E3No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes j2Mo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ffNo
19, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes f�'No
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 Za14
Air Quality representative immediately.
�Commeats {re%r tv ip�on �)'F.xpism ap4'Y�S�a�w�s s�mitor ate" oraaxy�o oo� �-- W � �`"
kUsc dr$wmgs,of'�«�ty t4"bet���gia� s�matia�s. {a�e'addi6�,Pages.as �? i_teld Copy ❑Final Notes ��
HV
Reviewer rName5
r .
ReviewerAWspector S/Inspecto ignature: Date: D
11/11/u.3 L:ont[T r"

Facility Number: -12
7 Date of inspection r
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes- allo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes -43 No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .E0 No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes .®'No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 12Vo
26. Fail to notify regional DWQ of emergency situations as required by General Permit? ,
(ie/ discharge, freeboard problems, over application) ❑ y E31Vo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes LINO
28. Does facility require a follow-up visit by same agency? ❑ Yes Q'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes PNo
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) -Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes .0 No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes Jallo
33. Did the facility fail to conduct an annual sludge survey? $Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? -ErYes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. .2 Yes ❑ No
❑ Stocking Form Wrop Yield Form ❑ Rainfall CInspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
❑ No violations or deficiencies were noted daring this visit. You will receive no further correspondence about this visit.
'" d .t.anai Corgi°�adf'Diawin �,- w" �"�
p
33 3 c N S I B e_ S �Lc vQ�) (3 (' C a ).b t-a Loyt s •
w A-4'A 0rx S t -10-- (e- ( (7
nyv Is Ale
3 S) P lea -se, Grc/p 9 i e S
lh
4ta C -if
12112103

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 1 Z, Date of Visit:
Permitted © Certified [3 Conditionally Certified © Registered
Farm Name: ... ..........................
J $'' ri ►'l'Pe-�ed'SO i j r�!'r `! .
Owner Name: JA`w gryoth _Pe4ers/b1
Facility Contact:
Title:
1®1 Di Time: I Z 1
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .....................
County:. U........................................ ;L._.....
PhoneNo: ................. ............................... ....... . . ....
Phone No:
MailingAddress: ............... . ..................................................
Onsite Representative: ... "Iet.... PkId.-3.. }` Integrator: „ % Vr'9k
.......I ................................................ W
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:.......................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude '• 6 46 Longitude • 1 «
Design
Somme Capacity
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
[ El Boars • ..
Trent' -
Design _Current _ Desigiu
Poultry. _Ca' aci Po ulatiori
❑ Layer
❑ Non -Layer
Cattle : 'Capacity._'.Po tiilation-
❑ Dairy
❑ Non -Dairy
Other
Total Design Capacity
Total SSW.
Number of Lagoons 1 ❑ Subsurface Drains Present Lagoon Area . ❑ Spray Field Area
"0!dhiig Ponds1Solid; Traps : ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? Cl Yes )21'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes P No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ,QfNo
c. If discharge is observed, what is the estimated flow in gai/min? lat
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes jffNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: ..............1........................................................ .
Freeboard (inches):
5/00
❑ Spillway ❑ Yes ;�No
Structure 4 Structure 5 Structure 6
..............................................................................................................
Conhinued on back

FaciH6 Number: _3 1 — J z3 Date of Inspection 10 I % 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 maintenancetimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AVRlicatiOn
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type '�r%r'jVd t Cn�l ^� ! �nci Z2 , S✓►.ul I j Ge^� i to
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?
Re uired 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?
0: 1Q Mo atio0s or 001:0 ncfes were nQtiet �i�x'irig thjs'vjsit! • Y;oO will •teceiW Ad tp} t�gr
co rrespondenke. alwuf:this viAL .. • . • . • . • . • . • .. ........................ .
❑ Yes ONO
❑ Yes JZ No
❑ Yes j2k
❑ Yes A No
❑ Yes T No
❑ Yes ;9No
❑ Yes RrNo
❑ Yes ,yNo .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes ONO
❑ Yes S2No
❑ Yes f2rNo
❑ Yes ❑ No
[:]Yes allo
❑ Yes JZ No
❑ Yes No
❑ Yes ® No
❑ Yes /.0 No
❑ Yes j] No
Comimen�{ of,facrhu bet#er.'e larri situations. (use
drlf d!©r any recommendettots or any other eommeats.,,
_9 } any YES
Use dra tp xii { tionsl`psges as necessary} - �
►�A wcPable-atcrFs' ?aK ka.s teaeti Acne 4vi be: used .
N&4e. -File -jeee 6dgv-,4 record 9 Shde.✓ ck A`OP 4-1o1,2Z f wee bi1r'kft .
4o 36 ineL-o I,&I - 6,1-I l01 4o S/ll/V ) . -Tti:s 4,,-,v/L•-.n4s)_�, o, vol v ,-.e el
ab0V%f �rjD 00 0 a j)pn.S.T�e ivv'r d;,Pn_ recar,4s- -hcLA) -�k
1 V?11 P 0.94 6kts cygre a i71 1;ed d V -r4;S je•t ves A bdt. t
40d.100A 041/,pnf unrieG6vr*Bd -tDr,T4I sees -4W eve foO-q-f;on
,.
Reviewer/Inspector Name T on C
Reviewer/Inspector Signature: �� s Date: q/gyp

Facility Number: 31 —1Z 31 Date of Inspection 1 1
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 '2rNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes,ZNo
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 J2'No
30. Were any major maintenance problems with the ventilation fan(s) noted? O.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover. ❑ Yes ErNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [] Yes ❑ No
Additional Comments all orDrawings: - —
d i'ff
dae s erence ,
5/00

r Dtveston of Water Qnaltty
QDotvts1on ofSoad,Water Cnser a tton
;` 0 Other Agency %.
A.
Type of Visit XCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit -A Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: GO Tine: � = � � Printed on: 7/21/2000
3
Q Not Operational Q Below Threshold
Permitted Certified [3 Conditionally Certified 0 Registered Date Last Operat d or Above Threshold: .
(((........................
....................... County. .-................./r.............�................
Farm Name: ........................................... y.................. 11� w.l�.�f'!�
Owner Name:...........................`.. ` Dl v�'1 c `'..` �1r................I..... Phone No........1�dL�,......................-2... .....................................
Facility Contact ....`�... ............... Title:................................................................ Phone No:...................................................
. .............................. .......... ........... F .! L�
Mailing Address: ...............�..�:.....��!V..- .1.1.....................................I........Y'.Ct..��.�t.c�.......A�.......................-.... �I..f.-...........
Onsite Representative: ..........
j2 .ri//.Ge°►�Integrator: ..........
....�........ ....................................
Certified Operator:... ............... �....5.
.......... V.c{.... Operator Certification Number
Location of Farm:
I I�
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� C.. Longitude �• ��
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Feeder to Finish ❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagn-n Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts Ko
1. Is any discharge observed from any part of the operation? ❑ YesDischargeoriginatedat: ❑Lagoon ❑SprayField ❑Other
a. If discharge is observed, was the conveyanec ratan -trade? ❑ Yes ❑ No
b- If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ lip
c. If discharge is observed. what is the estimated flow in gal/tnin?
d. Does discharge bypass a lagoon system9 (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes T0
waste collection & Treatment r
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Sjt�urtyre I Structure 2 Structure Structure 4 Structure 5 Structure
Identi Fier: ......... '7.tj--r-/--.... ....
Freehoard (inches):
5100 Continued on back

i
Facility Number: 3 — 123 Date of l.rispection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes f7CNo
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 X�10
(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
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes ?(No
�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes )!(No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes XNo
12. Crop type wp-
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, reaps, 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?
::10 yiolatigris:or defieieticies mere noted during fhis:visit; • Yoi� will receiveo further
corres�ondence. about this visit_ :... . ...:.:...: . : .... . :......... . . .
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes *o
❑ Yes KNO
❑ Yes XNo
❑ Yes XNo
❑ Yes 1No
❑ Yes )<No
❑ Yes >eNo
❑ Yes �RrNo
❑ Yes XNo
❑ Yes h(No
❑ Yes >(No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary):
cC I : �� i� ih �oo(�
�-"`saah jP.v�� w4s lac ozv 9�*-�-' -, y►r'. Cr�.emra,�5Li s4-c.ie
T
Reviewer/Inspector Name
v is (!:;� 1
Reviewer/Inspector Signature: y,[kL,o Date: LOW y/60 1 5100

Facility Number: Date of Imspection ®p Printed on: 7/21/2000
Odor Issues XYes
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 3t/or below ❑ 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 *0
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 XNO
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 peimanendtemporary cover? ❑ Yes j No
5/do

Facility Number Date of Inspection III/30
Time of Inspection jOQQ - 24 hr. (hh:mm)
® Permitted 13 Certified © Conditionally Certified Q Registered JE3 Not O eratianal Date Last Operated:
..........................
Farm Name: .................................................... F-`kr"^ County: P .1� 1; r►
h
�a C�✓���t�g�-,�lo> Z'S-
Owner Name: -.. ................... Phone Na:................
FacilityContact:..............................................................................Title:............................................................... . Phone No:.............................---...................
:Mailing Address:
OnsiteRepresentative: KP1`,, Jr?Y�n4V integrator:. .v��k r,°tr-,-A, FC,e,,s
................................................................................. .....F...................................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude Longitude • ��
Design Current :' - :Design.. Current ;,,. Design Current
Swine Capacity Population:.,-- Poultry Capacity Population Cattle- Capacity Population
❑ Wean to Feeder
Feeder to Finish
3 72
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons, 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
HoldrngPonds.J Solid Traps ❑ No Liquid Waste Management System
Dischar;ees & 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.? i
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
Identifier:
Freeboard (inches)
Structure l
f
2`?
.......... ............ :............
Structure 2
❑ Yes 191 No
❑ Yes ® No
❑ Yes ® No
n1 r,
❑ Yes RJ No
❑ Yes El No
❑ Yes ® No
❑ Yes JEJ No
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 19 No
3/23/99 Continued on back

Facility Number: 3 j — t Z3 Date of Inspection f I 36 °{9
6: Are thbre structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 9 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 0 No
Waste Annlication
I0.
Are there any buffers that need maintenance/improvement?
❑ Yes
9 No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
® No
12.
Crop type e r v dg Pr' -4u re ymci (j Gr''G r,
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
$j No
b) Does the facility need a wettable acre determination?
❑ Yes
K No
c) This facility is pended for a wettable acre determination?
g Yes
❑ No
15.
Does the receiving crop need improvement?
® Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
19 No
Renuired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
& No
18_
Does the facility fail to have alt components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
03 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
% No
... vioial. . . .o..... e.... mere noted• ...... ig tliis:visit; Yoi>t wiil receive Rio further ;
correspondence. abanit t$iis visit.
Comments refer to., uestion"# ;E . larn any YES -answers an" f t a t- m i
g hoaS. use.addtttonal " pages as. mendations or any other comments.'
ty p dfor au recom
9 xP Y
Usezdrawin 's of facil to better ex lain situa � ( p g necessary) t s
Vf ;r pen"A for G weA�ble AC--,r
1�It^. [c,verta��1. 5a;al +tXcc4 4�e t„jAA61a etc" da�errntrtGtl}imh i4
6�� �.9 "Prepared .
15, .Sage t,.,c� byre grea5 qn d dA�•.ar� � �r �,,.� -j-i�� ��-�c Ivs ;n .
av e
p�d 6 es�ub[; s►, �,.Zs G ro� r� +�ese jo LLt-�;, do s.
Also, broaAjeed' t,,Gecls" 1r1•srm.'r� 1-L,at.,ld 6� ner+rtvved�C,c�r,-}radieG�,
L'� nnC 5- k, 6d Vk 6 -- ck p � 1,. C q C C a rdG1 c) 4o sa " +c..f I t.✓, c I- ✓+rt � Ine l j
tV41., 4 hese ;.-,p eve-�e_h}s. Afro,.I work ka Fsget6l sk ilegss
Reviewer/Inspector Name rt,"
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Ne mber: 31 —I Z 3 Date of inspection 1130 �l
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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
9 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
9 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
X Yes
❑ No
bona om-men an or Drawings:'-,
oil} C a v e Qn tv a�e y 5 -t S� ►� a y-Fie s.
19. A new 1i0.s4v- Scow,19le- be 4od--e-n_ was4e qnn l.�s I S
4rf 9coot —60 O(c,r bete,-e A✓A 60 d4 yS at'F er- -fl e ekTe-
Dn 4�e Ann Lys ► s ,
T
3/23/99

Division of Soil and Water Conservation [3Other Agency 3
Division of Water Quality
N �
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 2
Time of Inspection Ao 24 hr. (hh:mm)
13 Registered Id Certified [3 Applied for Permit © Permitted 10 Not Operational Date Last Operated:
Farm Name: ............,.*. AN ..... F�,4.......................................... ..... County: ........
.DU4rs...................................
Owner Name:........................hlrw.t........ ..... .......... Lu StL.................................... Phone No: (°II.0) z- :.. Q.`.1..
Facility Contact: ............ ........ Title:.................. ....... Phone No:
MailingAddress:..........Q.... ... au.............................................................................1i! I lctS 1 ........................................... .......
Onsite Representative: ............................................4-.G.. . ".................................I. Integrator* :..... /.'` Ghf�?.!�j............................................................
�t4.vtAl�i}...
Certified Operator:............................................................................................................... Operator Certification Number:.............
Location of Farm:
r......1 s.... T .t�......Q �Qarr..1~aL,!. ...... i.!�.... .r !. ...} �! .....�: .....sli<..i.ol..3.....�.nK�....1 ................. J
....l!aUd............................................... I............I...-- .................I....... ................. ..................
Latitude �' �� �� Longitude 0. 0' 0"
`_? Design ,' Current ; Design Current W Design Curren#
n 4$wtne Oapacity'••Paptilatton Poultry Capacity Population Cattle > • Capacity Population
r
❑ Wean to Feeder JE1 Layer I I Dairy
Feeder to Finish 3 'j Z ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
s ❑ Other '
❑ Farrow to Feeder fi �.
❑ Farrow to Finish Total Design Capacity
❑ Gilts
Yn ❑ Boars Total SSLW
Number of Lagoons / Holding Ponds ❑Subsurface Drains Present ❑Lagoon Area 10 Spray Field Area ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes IN No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes (A 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 gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes 11 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ICI No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 0 No
5. ' Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes M No
maintenance/i mprovemcnt?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes (R No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes M No
7/25/97

Facility Number: 3 k — If
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsMolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier:
Freeboard (ft):.... ......... Z..................
W. Is seepage observed from any of the structures?
Structure 3 Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12, Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
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 WNW, or runoff entering waters of the State, notify DWQ)
15 Crop type 11r" t
❑ Yes No
❑ Yes No
Structure 5 Structure 6
............................................................... }
❑ Yes No
❑ Yes ® No
`& Yes ❑ No
❑ Yes ® No
❑ Yes M No
.......... .................... .....................----.--------.------....----•-.......----------.----.......--------...------ ...............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes RNo
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?
9
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewlinspection 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?
❑ Yes
(NNo
ID Yes
❑ No
❑ Yes
'M No
'M Yes
❑ No
❑ Yes
® No
0 Yes
❑ No
0-No.violations,ordeficiencies.were-noted-dluringthis-.visit.•Yo-114ill ieceive•no•furttier:
correspondence aliout -this:visit
❑ Yes 'M No
❑ Yes 0 No
❑ Yes ;.No
t Z. Dr_6rC �, a, (c yor,% wvA[% f>�,(J 6e. rthnove.l) . t-'- ao- C) C L _ tj c- l c 3 kd "Ij he_ mowed •
L v�5 yrccrv�'. Shoo loe- •a�f by S�rl pvi l I 0 s`r 3 'K� cerrc - `a-He-3 c. fbr tares
U - �a- c,��c.�+ ►� n� biro e�.. � �c� vac eS , E �,� ti �o i or. w p s ulk b e tin 6xrwl
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: A4,,7— / , AJ Date:

IS Routine O Complaint O Follow-up of DWQ ins ection O Follow-uR of DSWC review 0 Other
Date of Inspection E/. ► 11 !"� 1 1
Facility Number 31 f Z Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: 5a Registered Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review Z ZS
Q1 Certified Permitted or Ins ection includes travel andprocessing)
❑ Not Operational Date Last Operated:.... _ .. ..... ........... ».... ....._...... .... ..............._......_................_.................
Farm Name: .... [ _ C-agekW klk .. L'R rf%- _ ............ W ...._ ... County:.»`i l:x� ... ... _..........., _ . .._ »
Land Owner Name: I..... ........... Phone .......
Title: Phone No:...L.Ci.4�. a-la-1-_ -----
Mailing Address: ... . .._.................. __.. ........... . ..... L`� ....._....� Ge%-_...,
Onsite Representative: ..... . &t.-
epresentative:....... r� .... . _.... _......... _.... Integrator: _.�!".[y . _ ... _ ... ........... _ .... _ .
Certified Operator: fj4� 12.�_....» btu !� a 1 6
_..�...............................__....._..., Operator Certification Number: _.i.��.�__..... ..._....
�._.
Location of Farm:
,. .. ... C.:.... .. �..... •--- —
!n� W. .. c�. sif._..cwl----on _... ... .'- _.� .. ._` �. :_ ...._........ ._.............. _ . y
Latitude • ®� Longitude �• �0 «
Type of Operation and Design Capacity
Srvane De§ign &rrentIN,� x Desrgn C�rreat Des�g4 Current F
Y •: Ca 'ace P.o elation 'O°Itry . _ , Ca ac�ty ,1Pii elation `. x , ["attieyu . Ca aci Po ulahori
;.
❑ Wean to Feeder 10 La „❑
r Feeder to Finish ❑Non -Layer ❑ Non-
w
Farr o W - �,~°
Farrow t can � � r n.
r iN
Farrow to Feeder Total Deslgn'YCapacity
Farrow to Finish 15
2t�thVa:FY +3..'or� 1 ,»t�',{C>'3.aN%&� --+ I
Nrimber of Lagoons J Haldeng Ponds .�,��
n r
❑Subsurface Drains Present
,
oon Ar m„ ❑Spray Field Area
N Vr
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/rnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes j9 No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes
® No
❑ Yes
1p No
❑ Yes
® No
Yes
❑ No
Continued on back

Facility Number:... �... —..l.2
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7. Did the facility fail to have a certified operator in responsible charge?
Yes
❑ No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
14 No
Structures U agoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
EX No
Freeboard (ft): Structure i Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
,. .... .. _...................... ....... —............. _ ...... .... ......... .....
...
10. Is seepage observed from any of the structures?
❑ Yes
® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
&No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
�BNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
t9 No
(If in excess of WMP, or nmofffe"nteeriing waters of the State, notify DWQ)
15. Crop type i..... xuiU C,..... ......... ....... ............. ...... _Vlma.....9�!Wkl...... ....... ......... ................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
Wo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
❑ Yes
No
19. Is there a lack of available waste application equipment?
❑ Yes
& No
20. Does facility require a follow-up visit by same agency?
❑ Yes
® No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
For Certified Facilities
22. Does the facility fail to have a copy of the Animal Waste Management PIan readily available?
❑ Yes
No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
24. Does record keeping need improvement?
Yes
11 No
Coriirrients,(refer to questron #)� Ezplara any YES"answers=and/gr any recommendatrons or ariy other comments ,
}.
Use,drawingsoO facility toNbetter explain situations Y(use addrtionat pages as necessary} y
S. inar3G c�i�tYSions S%lovlr? be �YSS4. 4
CAvetnA�nk i5 ur�r► ec� e� +or b.,� moo{ �2s�5no.{ w� - 5{ak, i..e `` �'o
�A�t OU
iz. Rumver Owe- f com (ayft- 4hvuy- w0ak e�10!5c*.Soube ��. &Yt
S6,0 6e aseeT3%-k
-
v4. �,AW 5Pvj vi orris 61 64 AJ kjJ Avm6r:
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

1 -\
United States Soil
Department of Conservation P. 0. BOX 277
Agricutture Service KENANSVILLE, NC 28349
TELEPHONE [phone]
;.�.,.• WASTE MANAGEMENT FACILITY SITE EVALUATION AND MANAGEMENT PLAN
TO: PROD
' Vo Vey,
LOCATIDH OF SITE _Si\'� � � �V j Dwr) _ bQG
=ySIZE OF PROPOSED OPERATION
IS'SOIL SUITABLE FOR LAGOON?' FYES HO 50IC CLASS:
DISTANCE FROM THE LAGOON=SITE'TO NEAREST. RESIDENCE OTHER`THAH LANDOWNER OR HIS
TENANT i -42 D21'-(7CO�
NUMBER OF'HOUSES,WITHIN}2000 FEET OF LAGOON -SITE Q 34
ACREAGE%CROP "REQUIRED TO PUMP EFFLUENT `� GALS D r6SC.LIf ,
DOES LANDOWNER,HAVE.ENOUGH ACREAGE= YES NO
'-X.IF NO, DOES LANDOWNER -HAVE ACCESS TO MORE,ACREAGE? YES H0�
WILL FACILITY INVOLVE ALTERING WETLANDS? YESrNO;
IF THE ABOVE QUESTION CONCERNING WETLANDS I& CHECKED -'YES" THE LANDOWNER IS
HEREBY ADVISED THAT THIS CONSTRUCTION MAY REQUIRE PERMITS FROM THE ARMY CORP OF
ENGINEERS. IT IS THE LANDOWNERS RESPONSIBILITY TO DETERMINE IF PERMITS ARE
NECESSARY AND TO OBTAIN THE REQUIRED -PERMITS. THE ARMY CORP REPRESENTATIVE FOR
DUPLIN.COUNTY IS:
JEFF RICHTER,
.�- US ARMY CORP OF ENGINEERS
P. 0. BOX 1890
WILMINGTON, NC 28402
TELEPHONE [phone]
LANDOWNER IS RESPONSIBLE TO DETERMINE IF ANY LOCAL OR STATE ZONING ORDINANCES
AFFECT THE LOCATION OF THIS FACILITY.
A- DOES SITE MEET SCS CRITERIA FOR WASTE.TREA'i'MEHT FACILITIES?. YES NO
ADDITIONAL COMMENTS Dii a CK
THIS APPROVAL IS VALID FOR 60 DAYS FROM THE DATE SIGNED. IF DESIGN HAS NOT BEEN
COMPLETED WITHIN THIS PERIOD SITE WILL BE RE-EVALUATED AT THE TIME OF DESIGN TO
ASSURE COMPLIANCE WITH SCS STANDARDS. LAGOON WILL HAVE TO BE 750 FEET FROM ANY
RESIDENCE OTHER THAN APPLICANT'S AT TIME OF DESIGN.
® The SolConservation Seniea
is an agency
ency of the .--
Depanment of Agriculture SIGNATURE ATE

0
41
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