310124_INSPECTIONS_20171231

g 7VIA
NORTH CAROLINA
Department of Environmental Qualify

' iri"sion of Water Resources
Facility Number � � J -J - � �Division of Sail and Water Conservation '�
�Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: )outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j? 3 ! Arrival Time: Departure Time: County: /►-`Region:�,]f�
Farm Name: 'Zy ct.S•a h Ca'j±= 'tom } , ,,,_ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator: lM�rj
Certified Operator: �� �Qj,. � �e.��.,-,�—• Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Curren#
Swine Capacity Pvp. Wet Poultry C►apacity Pop. Cattle Capacity Pop.
Wean to Finish I JLayer Dairy Cow
Wean to Feeder I INon-Layer I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Dr, P.ouItr� C•.a a P,o P. on-Dairy
Farrow to Finish Lavers Beef Stocker
Gilts Non-La ye Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Ot urkez Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:] Yes 13110 [DNA ❑ 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 ,2rNo ❑ 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 LD-No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 12-leo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [:] No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Faciflty Number: - Date of Inspection: j3c
_Waste Collection.&Treatment
4 Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes ., No O NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes E-go ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): _3 3
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes .0 No ❑ NA ❑ NE
(i.e., large trees,severe erosion,seepage,etc.)
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [ o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWR
7.Do any of the structures need maintenance or improvement? ❑ Yes Jeno ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9.Does any part of the waste management system other than the waste structures require ❑ Yes [2-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes [2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ o ❑ NA ❑ NE
16.Did the.facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes .e'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 [2�No ❑ NA ❑ NE
Re uired Records&Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes _JD No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes,check ❑ Yes ❑'No ❑ NA ❑ NE
the appropriate box.
❑WUP [:]Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes . 3-No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L 'No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ Rio ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: JDate of Inspection: /Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes 2'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes �No ❑ NA ElNE
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 E�FNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes Z7 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ZNo ❑ 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 allo ❑ 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 fTNo ❑ 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 [E]'No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑"No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency El Yes I__I 1Vo ❑ NA ❑ NE
Comments(refer to question ft Explain any YES answers and/or any additioi>aFrecommendations'or any other comments.
Use drawings of facility to better explain situations(use additional pages as necessary).
re eor-a
Reviewer/Inspector Name: eL"I y.. Phone:
Reviewer/Inspector Signature: _-- Date:
Page 3 of 3 21412015

i�i`sion of Water Resources
Facility Number © - L Q° Division of Soil and Water Fanservation
i
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: outine Q Complaint Q Follow-up Q Referral Q Emergency 0 Other Q Denied Access
Date of Visit: IL f 2/ I Arrival Time: Departure Time: (?.' S� County: Region: p
Farm Name: UGZ3 a-i, o!fay yP Gc Ue2 L. � tJ�� Owner Email:
Owner Name: o y� �j �'�y Y.-,.� �y11. Phone:
Mailing Address:
Physical Address:
Facility Contact: _ i,Qw r 21 n^_ a e: �GU/,.r ,�-- Phone:
Onsite Representative: Integrator: �/
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pap. Wet Poultry Ca achy Pop. C►attle Capacity Pop.
Wean to Finish La er DairyCow
Wean to Feeder Non-La er I Dairy Calf
Feeder to Finish 4&
2 Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder D, P.oult. Ca aci P,o Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes ❑ 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 allo ❑ NA ❑ NE
of the State other than from a discharge?
Paige I of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3 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): !j
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ONE
(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 0 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 RLNo ❑ 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 RNo ❑ NA ❑ NE
maintenance or improvement?
1. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes [gNo ❑ 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): Ia
13. Soil Type(s): IA/d Jae,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �g[No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? [RYes ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ®,No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ® No ❑ NA ❑ NE
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 ❑X 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 0 No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and I" Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes [allo ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: JDatc of Inspection:
Y,
24. Did the fa ility 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 V[No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual s. , 1 r
❑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 [allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes [RNo ❑ 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 ELNo ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ® No ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31.Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes [LNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Co No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes fNo ❑ NA ❑ NE
Comimerits(refer to question#):Explain'ganygyES-answers and/or;any addihnnal,recomriiendatious' or any�oth'ir coiiimen,[s:
.r 3 {�_ ,a. :<.
Use dr4Wings;:of faaihty to bc�r,,explain.situations-(use;addit onal pages as neces ary,): i,
­571 �t1r? �ood
ralrn A a5
Reviewer/Inspector Name: r�y��-{ �3—� fir-,_�_ _ Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

- � Di'vi"sion of Water Resources
Facility Dumber - 1. © Division of Soil and Water Conservation I ':
Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: i
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �� j (1�jL-I cL-4-1 Integrator: /6
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish I 11-ayer IDai Cow
Wean to Feeder Non-La er IDairy Calf
Feeder to Finish OU Dai Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder 1), P,oult Ca act P,o . Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Other Turkey Poults
F-Fo-ther 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 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes J3'Vo ❑ 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 T o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

Facility Number: ��— Date of Inspection
T 4
Waste 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 PNo ❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes RNo ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes ZNo ❑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 J2No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes P'No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes PNo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes IZNo ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes /P?lNo ❑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 4:TNo ❑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 Qf o El NA ❑NE
18. Is there a lack of properly operating waste application equipment? El Yes VNo ❑NA ❑NE
;Comments(refer to question#�}:. Explain any YES answers and/or any recommendations or any athcr comments ri
Use drawings of facility to better explain situations:(use additional,pages as.necessary):
o�fC ��dOT1 AL
Reviewer/Inspector Name Phone: Y
Reviewer/Inspector Signature: Date:
Page 2 of 3 12 8/04 Continued

" iv"ission of Water Quality
cin Number - ] Division of Soil and Water Conservation
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ar f� Arrival Time: f�_ �7 Departure Time: County: Region:
Farm Name: `� ��5 o�i1 d.t PLIR�_ '�` � f;.L� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: J4 Gn Integrator: f71
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop, Cattle Capacity Pop.
Wean to Finish Layer Dairy Cow
Wean to Feeder I INon-Layer I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Dry Cow
Farrow to Feeder D , P,ouitry Ca aci P,o , Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Other Turke Poults
TO 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 ,0
No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes j2No ❑ 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 J�T No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:] Yes LZ No ❑ NA ❑ NE
3. Were there any observable adverse'impacts or potential adverse impacts to the waters [:] Yes 6/No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

[Facility umber: - ( Date of Inspection:
241iid"the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes J "No 'Q'NA ❑ NE
t�e
the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ❑ No ❑ NA ❑ NE
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 ,�o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes PI-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 1 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes j2rNo ❑ 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 eNo ❑ 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 E i10 ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ffNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes D<o ❑ 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).
(w A-
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7 � � It 7q 1
9 1 ups to �
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Dec C K C a m
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_� cS
Ifg2 -� ✓ - � _ -
Reviewer/Inspector Name: Q Phone: ( /
ReviewerAnspector Signature: Z ��� Date:
Page 3 of 3 l! // 214 011

`Division o'f Water Quality
Facility 1�lumber
- �-{---=��� OO Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
• Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: County: Region:
Farm Name: e� d6,- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ,.� � Integrator: rYl.
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet POUR ., Capacity Pop. Cattle Capacity Pop.
Wean to Finish I ILayer Dairy Cow
Wean to Feeder Non-La er I airy Calf r
Feeder to Finish airy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder D, P,nul Ca achy P,o Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Qther Turkey Poults
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 [:] No'
No ❑ NA ❑ NE
a 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 ❑ 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 21412011 Continued

Facili Number: e-
2,yj Date of Inspection:
Waste Colleefion&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes �' o ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? [—] Yes 0'-No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion,seepage,etc.) 112
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes J/'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7.Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;2No ❑ 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 r o ❑ NA ❑ NE
maintenance or improvement? T
11.Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes P 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_L3'No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes 'P�No ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ ❑ NA ❑ NE
acres determination? T
17.Does the facility lack adequate acreage for land application? ❑ Yes _La.Alo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �No ❑ NA ❑ NE
R uired Records&Documents
.19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes) 'i o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes C],No ❑ NA ❑ NE
the appropriate box. T
❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes JC:�Xo ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall [:]Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1"Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2,,No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes T No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

t
Facie Number: /- _3 Date of Inspection:
'24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ETNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ;2,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 Ca'Ro ❑ 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 7No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes �o ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31. Do subsurface the drains exist at the facility?If yes,check the appropriate box below. [] Yes P3,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 PrNo ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [�rNo ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes GR'No ❑ NA ❑ NE
Comments(refer to question#):Explain any YES answers and/or any additional recommendations or any other comments..
Use drawings of facility to better explain situations(use additional pages as necessary).
3 . of
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 - 1214411

ivi"lion of Water Quality
Facili Number I `�L� - O 11 CDivision of Soil and Water Conservation
T ©Other Agency
Type of Visit: 'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: -utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access /
Date of Visit: Q AMA7Arrival Time: �jn2 eparture Time: County: Region:yL/l2,
Farm Name: Owner Email: �TJ
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design C■urrent Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity P p.o Cattle Capacity Pop.
Wean to Finish JLayer I Dairy Cow
Wean to Feeder Non-La er I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean esign Current Cow
Farrow to Feeder Di. P.oulRMD'
a aci P■o , Non-Dai
Farrow to Finish Layers 6Beef
cker
Gilts Non-Layers der
Boars Pullets ood Cow
Turkeys
Qther Turkey Poults
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 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes 'KNo ❑ 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 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 HNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: 16
Wsste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes dNo ❑ 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)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 /ff No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation Poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes,.,o No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes VfNo ❑ 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 [alNo ❑ NA ❑ NE
maintenance or improvement? l�
Waste Application
10.Are there any required buffers, setbacks,or compliance alternatives that need ❑ Yes ,E:rNo ❑ NA ❑ NE
maintenance or improvement? ,�,/
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes I/�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)`"
❑ PAN ❑ PAN> 10%or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes HNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes,,J2]"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes JE2'No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [3'I o ❑ NA ❑ NE
Required Records&Documents Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes J[ZoNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes VNo ❑ 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_JZ-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 No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [21�o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

JP
Facility Number• - Date of Inspection: O
-4 Did,the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes No [DNA ❑ 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 A No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes No ❑ NA ❑ NE
Other Issues r
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:] Yes VNo ❑ 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 Mo ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30.Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes �(No ❑ NA ❑ NE
permit?(i.e.,discharge, freeboard problems,over-application)
31. Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes ❑/No ❑ NA ❑ NE
[IApplication Field ❑ Lagoon/Storage Pond ❑ Other: 7
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes V No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes VNo ❑ NA ❑ NE
Comments(refer to question#): Explain any YES answers and/or any additional recommendations or anf other comments.
Use drawings of facility to better explain situations(use additional pages as necessary).
$ �� lz C► :3 cefe' d� 5�
Iq r✓ -�� 'r-" t z_
G
4 c�7
;t jl 7 l
Reviewer/Inspector Name: Phone: ��/
Reviewerfinspector Signature: Date: 1v
Page 3 of 3 21412011

' a` vision of Water Quality
.Facility Number l - a ®Division of Sail and Water Conservation
®Other Agency
Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: O Arrival Time: lel,.3d eparture Time: County: --- =—� Region:
Farm Name: - - �ccr�_ {�rtCi�i�.u�2, rr�l Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: J ks nyi Integrator:
Certified Operator: Certification Number: 1 �3
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
lull!illll,l:�llIlllill'Illl Design @urrent Design _urrent Design Current
try Swine Capacity Pop. Wet Poul Capacity Pop. Cattle Capacity Pap.
Wean to Finish La er Dairy Cow
Wean to Feeder Non-La er Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design C**urrent Pr
y Cow
Farrow to Feeder D . P,oult, Ca aei_ P,o Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Other TurkeyPoults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [—] Yes [TNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes 25"No ❑ NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes ] 0
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Ifacility`Number: jDate of Inspection:
O
Waste Collection&Treatment
4As storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yesi No ❑ NA ❑ NE
a, If yes,is waste level into the structural freeboard? [-] Yes �fNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 2{�
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;2190 ❑ 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? /P31
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 structures 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 12'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ,[7fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. [-] Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s):
l3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes Ej No ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �] o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes JC2-No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �' o ❑ 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 Pro ❑ 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 Plqo ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stacking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and i"Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes g]No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24.-Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0No ❑ NA ❑ NE
23.Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ONo ❑ 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 allo ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? [:] Yes J21'go ❑ 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?
24.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes f!:r 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 0 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 .E:fNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E2'No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [EI'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:] Yes P31No ❑ NA ❑ NE
Comments(refer to question ft Explain any YES answers and/or any additional recommendations or any-other comments.1'_;=;"-'-"; ;. t
Use drawings of facility to better explain situations(use additional pages as necessary). .`
1. 7 1 0/d 671, 2-
1' ral''01 e /'CGo'-- Oj /ao�-jd oo?
8 1 `r ;�3 5��e
�
3 . �
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date: /
Page 3 of 3 1412011

vision of Water Quality
Facility NumberQaL20 Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 911compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technics Assistance
Reason for Visit Dr<outine 0 Complaint 0 Follow,up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:OF
Farm Name: rj^ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: /J Phone No:
Onsite Representative: ���.�,o✓L_ tlLL" `�� Integrator:
p p f 3 S a!o
Certified Operator: Operator Certification Number: _
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o ❑d Longitude: °
Design Current Design Current Design .: Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population-
❑Wean to Finish ❑La er ❑Dairy Cow
❑Wean to Feeder JEJ Non-La yet I ❑Dairy Calf
❑Feeder to Finish ❑Dairy Heifer
❑Farrow to Wean Dry Poultry ❑Dry Cow
❑Farrow to Feeder ❑Non-Dairy
❑Farrow to Finish ❑La ers ❑Beef Stocker
❑Gilts ❑Non-Layers ❑Beef Feeder
❑Boars ❑Pullets
❑Turkeys
El Beef Brood Cowl
Other ❑Turkey Poults
❑Other I I ❑Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes ❑No ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(if yes,notify 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 ❑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 adverse impacts or potential adverse impacts to the Waters of the State ❑Yes ❑No ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: — Date of Inspection Z
Waste Collection& Treatment
4., Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes ❑No ❑NA ❑NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑No ❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes ❑No ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes ❑No ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ❑No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes ❑No ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes ❑No ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes ❑No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes ❑No ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or l0 lbs ❑Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes ❑No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes ❑No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes ❑No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes ❑No ❑NA ❑NE
�Coiimenis(refer.to-question-ft Explain any YES�ansKers andlnr any'recommendauons or any othe icon nts .�
Use drawings of facility to better.explain situations (use additional pages as necessary) ,
, _.
i
tl� t 4-- 0—T C. Cc(
c. ��' �} /� L a►r'd� 3 16s 5,1 Uc�
Reviewerllnspector Name , x Phone:
Reviewerllnspector Signature: Date:
Page 2 of 3 12, 8/04 Continued

Facility Number: 3 — Date of Inspection 2 7�
Required Records&Docume is
19.'Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes ❑No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑yes ❑ No ❑NA ❑NE
the appropriate box. ❑ WUp ❑Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes ❑No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑Waste Transfers ❑Annual Certification
❑Rainfall ❑ Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1" Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ No ❑NA ❑NE
23, If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ No ❑NA ❑NE
.25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑ No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes ❑ No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ❑ No ❑NA ❑NE
Other lssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes ❑No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes ❑ No ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes ❑ No ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes ❑ No ❑NA ❑NE
General Permit? (ie/discharge,freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes ❑ No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes ❑ No ❑NA ❑NE
Tonal Cbmme nfs aiidlo�Drawings
713�10
r/
-7117,111
/j //0 :� r
Page 3 of 3 12/28/04

�•ision of Water Quality
fF ill , Number = c3 0 Division of Soil MEMO C•onservatiun
Q Other Agency
Type of Visit 6Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vis Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit: j ,rArrival Time: R Departure Time: County: Region:
Farm Name: J t�S U1-` C�✓�_� �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: c Longitude: =o =,
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population C►attle Capacity Population
❑Wean to Finish 10 Layer ❑Dai Cow
❑Wean to Feeder 10 Non-Layer I I ❑Dairy Calf
❑Feeder to Finish ❑Dairy Heifer
❑Farrow to Wean Dry Poultry ❑ Dry Cow
❑Farrow to Feeder ❑Non-Dairy
❑Farrow to Finish ❑Layers
❑Beef Stocker
❑Gilts ❑Non-Layers ❑Beef Feeder
❑Boars ❑ Pullets
❑Beef Brood Co
Li Turkeys
Od 10 Turkey Poults
❑Other ❑Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes fZ/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 ❑ o ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? El Yes
o El
NA [I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

0 do
Facility Nutnber: Date of Inspectiion / f
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes [Wo ❑NA ❑NE
a. If yes,is waste level into the structural freeboard? ❑Yes ;allo ❑NA ❑NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes [,_;�No ❑NA ❑NE
(iel large trees,severe erosion,seepage,etc.) /
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 1�lNo ❑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 LRNo ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes Fer1Vo ❑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 9Xo ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑ Yes ❑ o ❑NA ❑NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or 10 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes O El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑Yes f❑No ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [�No ❑NA ❑NE
18. is there a lack of properly operating waste application equipment? ❑Yes ENo ❑NA ❑NE
Comments(refer to question#):" Explain any YES answers and/.or any recommendations or any other comments.
Use drawings of facility to,�better=explainysi"tuaho�s:{use�additional pages as necessary).
Reviewer/Inspector Name j .1 Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12,28/0 Continued

Facility Number: Date of Inspection
17e uired Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes [�_, o ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes fl-No ❑NA ❑NE
the appropirate box. ❑WUP ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes [3 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 [a-No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes -fN-;o ❑NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes � �vo ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes .,ET—No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes ,E3No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ,EMo ❑NA ❑NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes ,[3<o ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document 0 Yes 13'-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 JETNo ❑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 VNo ❑NA ❑NE
General Permit? (ie/discharge,freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes 9No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes �iNo ❑NA ❑NE
Additional Comments and/or Drawings:
AL
Page 3 of 3 12128104

IrM
i��sion of Water Quality
aCllity NnmbeC �� w-�— �� O Division of Soil and Water Conservation
Other Agency
JType of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit142�fioutine O Complaint O Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 1 o Arrival Time: UQ Departure Time: County: �IZ� Region:If /
Farm Name: c�CtAC) ''N �C�ti/�I�C.�I���.�� �J� _ _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _�S ate C�oe in r L� _ Integrator:
Certified Operator: Operator Certification Num er:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o Longitude: [=o
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑La er ❑ Dairy Cow
❑ Wean to Feeder ❑Non-La et ❑ Dair Calf
Feeder to Finish 7C',O O ❑ Dairy Heifer
Farrow to Wean Dry Poultry El Dry Cow
El Farrow to Feeder ❑Non-Dairy
❑ Farrow to Finish ❑ Layers ❑ Beef Stocker
❑Gilts ❑Non-La ers
El Pullets ❑ Beef Feeder
❑ Boars [] Beef$rood Cowl
_ -- --- - - ❑Turkeys - -
Other ❑Turkey Pouets
❑Other JE1 Other Number of Structures:
Discharges& 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 than-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 ❑No ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes rNo ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes AD No ❑NA ❑NE
other than from a dischar
�r 12128104 Continued

Facility.Number: — 0111 Date of Inspection
Waste Collection& Treatment
Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes `EM ❑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: Z
Spillway?: i
Designed Freeboard(in): l S l
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes 2No ❑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--Ej`No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes CjNo ❑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 FI-No ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes,4ErNo ❑NA ❑NE
maintenance/improvement? ,�
nf
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ElE Yes o ❑NA ❑NE
❑ Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or 10 Ibs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drifl ❑Application Outside of Area
12. Crop type(s) _S'6
13. Soil type(s) C
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes fTNo ❑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 Jallo ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes AETNo ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes`g"lgo ❑NA ❑NE
ACo�mentys E(refet r4 t o questto3n# Explaiuw�a nys YES 1 "It. '.:
:an ran �recmmendation r
w ,
s '
arRany other comments ,
�.
Usedrarvingsof facility to'8better e$plain sttuattons (use�addihona)I�pages�as necessa�ry)•�� �� � .,l f�� _
Reviewer/inspector Name , ---� Phone: X5.7. 4 —70- O EIy
Reviewer/inspector Signature: L Date: /1 Z
I2/28/0 Continued

Facility Number: 3 — Date of Inspection � /s-
Required Records&Documents
1P. 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 E No ❑NA ❑NE
the appropirate box. ❑WUP ❑Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement?if yes,check the appropriate box below. ❑Yes P-No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑Waste Transfers ❑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? ❑Yes'Jallo ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes 'E No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes No ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes N No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes E)No ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes Z No ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes JD-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? [:1 Yes_L]'1�o ❑NA ❑NE
Additional Comments and/or Drawings:
.2y -5)_ Ye -uA e
4F, 27
V, Ce/ s/uc
kd
12128104

�`" Ca.,.'`, sR- -`"+?`"�. Sfz". xaz-
iF ��x' "-�`z,'�.ri.,. ?F -tic'"��r -•, -i.
,z
.� � •�.-''k �:`s!r�� -�+S`,G.tea" r
4y � .��'� �:�`ro.� i -�"�;� '.'3 ��\7_YiF��'b_-.�'n•ar���� F`��,� •rzs�.�s*���„ y� ���a.� ";'� ,�' � 4i
Type of Visit Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit XRoutlne O Complaint O Follow up O Emergency Notification O Other 0 Denied Access
Facility Number 3 Date of Visit: V
J� 7` Trine:
Q Not erational Q Below Threshold
13 Permitted 13 Certified 0 Conditionally Certified 13Registered Date-Last Operatedor Above Threshold:
Farm Name: s 2 a so.el -Gli�'(a_ .L County: Lei12 1 Ck
i
Owner Name: ___._ _ . _. Phone No:
h+Iailin Address:
Facility Contact: __ ---Title: .. __ .._ _ _ ___. Phone No:
Onsite Representative:; rl� w Integrator:
Certified Operator. ,w .. Operator Certification Number:
Location of Farm:
♦i
�1
❑Swine ❑Poultry ❑Cattle ©Horse Latitude Longitude �•�� ���
9Design .Curreat Des
rgn Cnrrnat .-
Des zCarreat
4
Swore Ca :Po lion p.;,Poaltry�: city 4Po hori; Cattle 4:Po hon
Wean to Feeder Layer Dairy
Feeder to Finish Non-Layer Non-Dairy
Farrow to Wean
Other
Farrow to Feeder -
Farrow to Finish ,t
El Gilts
El Boars "' Total°SSLW='
r
Nmnber of L�gooas s ��,�;
Discharges&Stream hnpa
1. Is any discharge observed from any part of the operation? ❑Yes 2110
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) [I 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 ,B No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes ,,01Vo
Waste Collection&Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes J2-No
Structure 1 Structure 2 Structure 3 Stricture 4 Structure 5 Structure 6
Identifier:
Fecboard(inches):
12112103 Continued

Facility Number: j — Date of Inspection
5. Are there•any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑yes ONo
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑Yes �o
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 ]' o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes J2'So
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level ❑Yes S2-No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes �-No
11. Is there evidence of over application? If yes,check the appropriate box below_ ❑Yes r -t4D
❑Excessive Ponding ❑PAN Hydraulic Overload ❑Frozen Ground ❑Copper and/or Zinc l''�
12. Crop type c• ^/ F'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes J2*fqo
14. a)Does the facility lack adequate acreage for land application? ❑Yes _L3-No
b)Does the facility need a wettable acre determination? ❑Yes 'P No
c)Ibis facility is pended for a wettable acre determination? ❑Yes E io
15. Does the receiving crop need improvement? ❑Yes 01So
16. Is there a lack of adequate waste application equipment? ❑Yes Pio
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑Yes �No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑Yes 2-No
19. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes JKo
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 .-tvo
Air Quality representative immediately.
VA
�.� - ..sue---s-,, <------.�-.-.;��r-`- .:.:L' ��t s-a
���Yid answ S IOr any'' Man Aothif Cammmf:�.._
�
Else drawings cI tatty�to lr a glam abaatiaas.(tee a�ditioasl P YY Feld Final Notes
=-
��n-� � ���-C� S a1�C�. c� �XceI1G►� S c�J�-
Reviewer/Inspector Namerdl
ReviewerAnspector Signature: Date: l 451
IM2/03 l Coined

Facility Number; 3 — Date of Inspection
Required Records&Documents
21. Fail to have Certificate of Coverage&.General Permit or other Permit readily available? ❑Yes �13<0
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 ,ONo
23. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes 1211gO
❑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 O No
25. Did the facility fail to have a actively certified operator in charge? ❑Yes Z3 No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge,freeboard problems,over application) ❑Yes O1Qo
27. Did Reviewer/Inspector fail to discuss reviewfinspection with on-site representative? ❑Yes XjNo
28. Does facility require a follow-up visit by same agency? ❑Yes JD-Ko
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ;LNo
NI MES Permitted FacHities
30. Is the facility covered under a NPDES Permit?(if no,skip questions 31-35) ZrIfes ❑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 Z No
33. Did the facility fail to conduct an annual sludge survey? ❑Yes J2No
34. Did the facility fail to calibrate waste application equipment? ❑Yes ®No
35. Does record keeping for NPDES required forms need improvement? If yes,check the appropriate box below. ❑Yes Z No
❑Stocldng Form ❑Crop Yield Form ❑Rainfall ❑Inspection After 1"Rain
❑ 120 Minute inspections ❑Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
otial6C�omsnents�andliiDtawg -
12112103

r
a
Dlvistun of
� Q Divtsiaa of Soil aa+i Water Coaservatfino
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (25 Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑Denied Access
Facility Number Date of Visit. Time: 1
10 Not Operational Below Threshold
J6 Permitted 0 Certified 0�Clonditionaliv Certified ©Registered Date Last Operat r Above Threshold:
Farm Name:
-c� L i County VaP«d
w�
Owner Name: __ )MEP) ajEa AUr'44- _ _- _ Phone No:
Flailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: Mag Ptlq _
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude 0' �•
Design Current -`a Desigrt Cterrent Destgu :Current
Swine =_ Ca aciri. Population ` Poultry C �scity -Po elation cattle:: Ca acitr _'Population `m
❑Wean to Feeder ',:;❑Laver Dairy
-i
Feeder to Finish ; ;❑Non-Layer W-❑Non-Dairy
Farrow to Wean -
❑
Farrow to Feeder Other
❑Farrow to Finish 7TotaLDesign G m.apac
❑Gilts
❑Soars v Total SSLW
Numbera�f Lagoons © ❑Subsurface Drains Present ❑Lagoon Area JE1 S rav Feld Area
Holding Ponds 7 Solid Traps ❑No Liquid Waste Management System
nkcharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ❑No
b. If discharge is observed,did it reach Water of the State?(If yes,notify DWQ) ❑Yes ❑No
c. If discharge is observed,what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes 096 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes r No
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes ONO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,0`ti
Freeboard(inches):
05103101 Continued

Facility Number: 9,1 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes 0 No
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes m No
(If any of questions 4-6was 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 O No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes No
11. Is there evidence of over applicatio ? Excessive Ponding EAN ❑Hy aulic Overloa ❑Yes No
12. Crop type t D)F.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes No
14. a)Does the facility lack adequate acreage for land application? ❑Yes No
b)Does the facility need a wettable acre determination? ❑Yes No
c)This facility is pended for a wettable acre determination? ❑Yes No
15. Does the receiving crop need improvement? ❑Yes No
16. Is there a lack of adequate waste application equipment? ❑Yes No
Required Records&Documents ,�(
17, Fail to have Certificate of Coverage&General Permit or other Permit readily available? El yes ICJ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? ,
(ie/WUP,checklists,design,maps,etc.) El yes X J No
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) ❑Yes /�No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes ]No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes No
24. Does facility require a follow-up visit by same agency? El Yes X, o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments(refenta question#) `Expkain`any YES answers and/or any recommendatton§or anv,other:comuients.
Use tirawtn s of facility to b `eirplatn situat,©tus.(nse stddittonak pages as necessary) ;i�Field Copv
b
El Field Final Notes,
TEEo
/(0 H,
f
Reviewer/Inspector Name
Revieweranspector Signature: Date: D�
05103101 Continued

` Facility lumber. — Z Date of Inspvction
Odor Issues
I su
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ElYes ElNo
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 anv evidence of wind drift during land application? (i.e_residue on neighboring vegetation,asphalt, ❑Yes No
roads,building structure,and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes/No
30. Were any major maintenance problems with the ventilation fan(s)noted? (i.e.broken fan belts,missing or //
or broken fan blade(s),inoperable shutters,etc.) ❑Yes A No
31. Do the animals feed storac, bins fail to have appropriate cover? ❑ Yes �o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes //❑No
Additional"Comments and/or Drawings:
05103101

�0'I)Wvisioii Ol' `i31l8YNl $tSet'CanSClYAti¢n i � .
V;Other Abe" i•.e- a�rsr ^�"`�--s-� .s' '^-"� �r;^r� �y
Type of Vislt eCompliance 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. 12 Date of Visit: i D t Time:
NNot O erational Q Below Threshold
©Permitted [3 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: _ ._ . . ..
Farm Name: i� Son ✓e11.cVJ.k � County: ...P—Mr. :. ..... ....... _.
Owner Name: ......... ..rSe.: .......Cq .....
............... Phone No: ............................................................................_..
FacilityContact: .....................:........................................................Title: ................................................................ Phone No:
MailingAddress: ..................................... ------•......................................... ...... ...
Representative:... I T ..........CAorehe,v J� ........................ Integrator: 1 '►
Ons�te
...... ............... ........ ...................P...l....................
Certified Operator:................................................... ......................... .--. Operator Certification Number:
................................ ..........................................
Location of Farm:
�I
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude �o�° ��� Longitude
Design: Current Design . Current Design Current -.
W`Ca ac -,Population Cattle Capacity, PeatonS Poultry
i
Wean to Feeder . ❑Layer ❑Dairy Es
:
Feeder to Finish ❑Non-Layer ❑Non-Dairy --
❑Farrow to Wean -
�-
Farrow to Feeder ❑Other_
Farrow to Finish Tobi—Design Capacity
Gilts
F ❑Boars Total SSLW =-
...-_ .._.Number.of Lagoons - -
Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
g ps ❑No Liquid Waste Management System l3oldin Ponds t Solid Tra . .
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes 01<0
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 Ej'No
c. If discharge is observed.what is the estimated flow in gal/min? h Ax
d. Does discharge bypass a lagoon system?(If yes, notify DWQ) ❑Yes j2rNo
2. Is there evidence of past discharge from any part of the operation? [3 Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes PTO
Waste Collection &Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes 'ONO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............;].:;................ .........T7.................. ................................... ....................................
Freeboard(inches): 35 TZ-
5/00 Continued on back

)F'asility Number: 31—/2 Date of Inspection O 3
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes No
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes XNo
(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 JKNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes XNo
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes 'A 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 P(No
12. Crop type Rerv--v4e,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes XfNo
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 VNo
16. Is there a lack of adequate waste application equipment? ❑Yes gNo
Reguired_R_ecords&Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes eNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes &No
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) ❑Yes ,fNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes R'No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes EfNo-
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes ANo
24. Does facility require a follow-up visit by same agency? ❑Yes �fNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes JVNo
Q'Y1Q���1Q14S.9 d f Cie VixPCE nQte4 d0iftg th15�v}s}t;•y00 30 •teoiye dq futthof
'COrres oridence:about this visit
Comments(refer to geeesdiin#} =Explaen auy YES answers andlor any recomimieeedations or iiny uthex eammenik - F
- _ - - -
Use drawings of fac ty to better explain situations: use unal Pages as necessaryA.
-rr��
fir. C,yrenaulll rats A has -s �y�,
oI -kct, „t awes Lvf i s A44 .surd �� L,>AjePv i• - Lv� Gort'o le-led
�. Se S V r e �-o use q w4.y-�e Ina./7 S;s d g4ed l.✓1'4k;n Go (1,i7 s of
,,,r f 1: r 4.t,,j eve ns far Gllc+,let4;^j PAN aff l,'M on AE' TKR-Z's.
TG,e ber,�t�d5 crdp weld es���l,'sl,ed artd �s sZy'r'
�f4 iris 40;on: , Z"te�lI��ke �ac;f,'� crd ta1 are moo/ ke(4, —
Reviewer/Inspector Name , ' dyl cliv w-Ia
Reviewer/Inspector Signature: Date: Z 4 sm

FacilitrNttmber: j — Z Date of Inspection ZJ U
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑Yes ❑No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes ONo
28. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes 9No
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 �6No
30. Were any major maintenance problems with the ventilation fan(s)noted? (i.e. broken fan belts,missing or
or broken fan blade(s), inoperable shutters,etc.) ❑Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes/No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes ❑No
Additionalomments an or rawings:..
AL
5/00

Plan Amendn>tcnt to 16dndi S&WCC Chronic Rainfall Practices and Standards
.., _ S throngs March131,2000
� . . ._.
ty
-1: If this faci' ram otimply it`ssxisiing permit mad-CAWMP it must do so. - -
2. Temporary Addition of New Sprayfields(0)(Check appropriate boxes.)
[]A. acres of a-opland. List crop types used:
[j B. acres of hardwood woodland Q 100 lbs PAN I acre added.
[ C. acres of pine woodland added 0 60 lbs PAN f acre added,
3. Summer Perennial Grass(Check appropriat�x.)
[K Application window extended for � acres of perennial grass until first killing frost.
B. An additional SO lbs of PAN applied to acres of perennial grass prior to killing frost.
4. PAbj Application Increased for Small Grains&Winter Grassesp be harvested.(Check appropriate box.)
PAN application increased up to 200 lbs per acre forte_acres of small grains or winter-grasses to be Harvested
0 B. PAN application increased up to 150 lbs per acre for acres of overseeded summer perennial included in 3.B.
S. Waste Analysis(Check appropriate box.)
[/A. Prior to December 1�. 1999 the calculation of Pjk4N will be based on a 35%reduction of the last analysis taken
prior to the first 25 year 24 hou=storm event. (current waste analysis must be.used after Dec.l".)
0 B.Use current waste analysis to determine PAN.
6. Required-Maximum Nitrogen Utilization Measures for Small Grains and Winter Grasses.
A. Use of higher seeding.rates,
B. TimeIy.hirvest of forage to increase yield, and
C. Irrigating during periods of warmer weather.
7. Required-Irrigation Management Techniques to Reduce Runoff and Ponding Potential.
A_ Making fx-...quent,light irrigation applications,and
B.- Not irrigating immediately before predicted rainfall.
8. The owner manager is required to manage the movement of animals to and from the facility to minimize environmental
impacts, ensure compliance with the facility's permit and amended CAWMP,and avoid discharge to surface waters_
9_ Authorization to use the additional practices included in this amendment expires if a facility discharges to surface waters_
Any discharLm is a violation and may result in an enforcement action.
1D. The owner 1-operator is required to keep records of all waste applications.
11. This revision must include a map or sketch of new land application areas.
Facility Number o A C X We-14 � FL
FaciIity Nam
ct r0,1 Ca l e.4 rA-I ✓ v D
Facility Owner 1 Manager Natn-(PR I-T) Tech ical Specialist Name(PRLN-
i'i
acility Owner 1 Manager Signature Teq nical Specialist Signature
Date 1 Date
This document must be filed at the SWCD office and be attached to the facilities CAW-NIP
and be available for inspection at the facility.
•)New temporary sprayfields must meet applicable buffer and setback reAuirements_ Waste must not be applied to wetlands.

_ _ivision of Water Quality.
• a
Q Division.of Soil and Water Conservation
Other"Agency
Type of Visit Xcompliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit XRoutine O Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: © Printed on: 10/26/2000
Q Not Operational O Below Threshold
J§Permitted ©Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ........................
Farm Name: J "Ir-__� C��2•—c c,`� County: ........11.�-AkL- ............................ .......................
........ ........................................ ..................................................... r....
OwnerName: ................................................... ........................................................................ Phone No: .......................................................................................
FacilityContact: ..............................................................................Title: ................................................................ Phone No: ...................................................
MailingAddress: ..................................................................................................................... .....................................M................1............................... ..........................
Onsite Representative:...O�e`r Integrator:....... „',` ,`��i
.......................................................................................... ..................................................
Certified Operator:................................................... .. Operator Certification Number:............,
Location of Farm: _
ri
[]Swine []Poultry []Cattle []Horse Latitude �'�� ��� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish 723Tj JE]Non-Layer I I ❑Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder Other
❑Farrow to Finish Total Design Capacity
❑Gilts
❑Boars Total SSLW
Number of Lagoons ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding Ponds/Solid Traps ❑No Liquid Write Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes kNo
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made`? ❑Yes ❑No
b. If discharge is observed,did it reach Water of the State? (if yes, notify DWQ) ❑Yes ❑No
c. if discharge is observed. what is the estimated flow in gal/rrtin'?
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 kTNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from,a discharge? ❑Yes kNo
Waste Collection &Treatment
4. Is storage capacity(freeboard plus storm storage) less than adequate? ❑Spillway ❑Yes k(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................
Freeboard(inches): 21 `I
5100 Continued on back

Facility Number: '3 Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes gNo
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes 6�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 ):�INo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑Yes �(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? • Yes ❑No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes ONo
11. Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Hydraulic Overload ❑Yes ONo
12. Crop type be , A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes 4No
14. a)Does the facility lack adequate acreage for land application? ❑Yes ONo
h)Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? jffYes ❑No
15. Does the receiving crop need improvement? ,KYes ,CNo*k-
16. Is there a lack of adequate waste application equipment? ❑Yes N�No
Required Records & Documents
17. Fail to have Certificate of Coverage&General Permit readily available? , Yes ❑No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes ONo
19. Does record keeping need improvement?(ie/irrigation,freeboard, waste analysis&soil sample reports) ❑Yes b4'No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes N'No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes 1UNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems, over application) El Yes �No
23. Did Reviewer/Inspector fait to discuss review/inspection with on-site representative? ❑Yes ,�No
24. Does facility require a follow-up visit by same agency? ❑Yes krNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes allo
0; Q Yiolaiid s o. defeiet�cies rare pbtet3 ditrirtg this;visit;•Ybi}will•r;eceiye iiti further ;
•corres' orideitce:abi k this visit:
Comments(refef to question#):, Explain any YES-answers and/or'any recommendations or any otlier comments:'=
Use drawingsof fa to better explain situations. use additional pages as neces --
h' P ( _ P g nary).. _- - - -
1 Cls. _ s� > �t�a2 -� G� VIPcj-L�
`a-Lf 11+^c�a s ��s��w�-d \ ` o. j GtT 1, Ct;t��\�` LA <<t
o
s�e�Z�tsr ve�-i . �� t-��L��2 ►���e�- �'F-+-���c� . A�a�s`�
Reviewer/Inspector Name ��►.� (�+. Q q�G-- s 3 Ci G �--aa6
Reviewer/Inspector Signature: Date: 'Dk--4�;-00 5100

• Facility Number: 31r —�a[ Date of Inspection 7 UZi Printed on: 1 0/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Kyes ❑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 ArNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation,asphalt, ❑Yes �AI0
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 ONO
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 permanentltemporary cover? ❑Yes .`INo
Additional omments an orDrawings: ,
cc
5100

r -
r s _ 13 Division of Soif and Water;Conservation Operation Review
�. - - a
_ _ -
x (]Drns�oA of SOiI and Water Conservation Comp!aACe Yi1SpectioA a '
x ®Division of Water Quality "i;Compliance Ipecdon �
' Q Qtllet'AgFACy. OPFratioi�
_
0 Routine O Complaint 19 Follow-uE of DWQ ins ection 0 Follow-u of DSWC review Q Other
Facility Number 3/ J2 Date of Inspection S 00
Time of Inspection 153 24 hr.(hh:mm)
©Permitted 0 Certified 0 Conditionally Certified []Registered 3 Not O erational Date Last O erated:
A ..........................
Farm Name: ` .'�e... 4 t/ c, � County: ...-�Z?Vi�'
��, o-n.._..C.... "�....... .....: ........ ...................... Sri.........................._.._.. ..............---..._..
....... .....
Owner Name: ` e e..C�v i. Phone No
................................................... .. . ..:!.........................................
FacilityContact: ..............................................................................Title: ................................................................ Phone No: ...................................................
MailingAddress: ...................�. ....................................................._..................._..................... _...............................,.............................................�.....t.s.... ..........................
Onsite Representative; df] Cat✓e rI C-L J V e'04 '
.................................. .......J_ - ..... Integrator:,•• ' ......................................................
Certified Operator:.................................................:. ............................................................. Operator Certification Number:..........................................
Location of Farm:
:.....
Latitude ���� �•' Longitude
Design Current Design Cur' "ent: .DeikA .,Current
Swine Poultry attley Ca ci ' Po ulat,on
❑Wean to Feeder JEJ Layer ❑Dairy
❑Feeder to Finish ❑Non-Layer ❑Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other = _
❑Farrow to Finish I F Total De51gn`Capaclty _
❑Gilts ,
❑Boars _Tota!,SSI:W
Holding
Number of Lagoons 2— ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area ,
ding Pondsl SolidTraps []No Liquid Waste Management System s Discharees &Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes ❑No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑Yes []No
b. If discharge is observed,did it reach Water of the State?(If yes, notify DWQ) ❑Yes ❑No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes ❑No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes ❑No
Waste Collection &Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes AN No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LP f P 5A}
Freeboard(inches): 2 5 Z
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes ❑No
seepage,etc.)
3/23/99 Continued on back

Facility Number: 3/ Date of Inspection DU
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ❑No
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? M Yes ❑No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑Yes ❑No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes ❑No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes ❑No
IL Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Yes ❑No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes ❑No
14. a)Does the facility lack adequate acreage for land application? ❑Yes ❑No
b)Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? ❑Yes ❑No
15. Does the receiving crop need improvement? ❑Yes ❑No
16. Is there a lack of adequate waste application equipment? ❑Yes ❑No
Required Records&Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes ❑No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes ❑No
19. Does record keeping need improvement?(ie/irrigation, freeboard,waste analysis&soil sample reports) ❑Yes ❑No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ❑No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes ❑No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems,over application) ❑Yes ❑No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes �TNo
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
. . . I yi. . ..r. .. deficiencies were. . i!>. ...t. . ..s. . . . . .will fart gr -
corres oridence'abouf this visit: . . . . . .
Comments(refer to;queshon#) Explain anyYES,answers and/or any.recnmmendatrons or::any other comments ' �'
v-
-Us e;(Irawtngs of facdtty to better:explainsituations {use addthonal pages as necessary) J ' t
6 '', .
�hs�acG-�ivi, �e✓Far,�-.eo! as a ffoW �� �tis� _DWJ
.. 'DisG1 JIle
1P pcS 4-0V" k�ott.xeS +4 jet ao►`t i')eefil
►/^eta; �e svGl, ��a'y 1;� '�{ 44J. ►-1a ;�+, dam►►-ta5 �9 la yoah Gv�ll,
Cd P'z Pipe 10 cat 111A,904011
Reviewer/Inspector Name �a n G ..- l .; ..-1 -t` `if: ql,?) 4.Q�' T
Reviewer/Inspector Signature: - Date: �Q

r l Division of Soil and Water"Conservatzon Operation Review 9 . a
0 Division of Soil and Water,Conservatioa` Comphance'Inspectton
Division of Water Quality -COnlphance In5r0.eCdOA �Fb r. a } '
_13 Other Agency=Operahon
_.��.:.--�1-f'.•'c..�1'1-�.,=��_= Yam.. :.. r..A.a^-s�.�..Y^��u-suZs.=<�.r-yiaY,.F�.S- .t. 'fin. .�.._i.,_r� -�.�,.=��_ :-tom ..������'�
L0 Routine Q Complaint O Follow-_up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number 3j Date of Inspection 2 $ 20G17
Time of Inspection t 5 ?A hr.(hh:mm)
[] Permitted ©Certified '[3 Conditionally Certified [3 Registered Not O erational Date Last Operated:
FarmName: _ County: ... .U . ..."4................................ .......................
Phone No:
gSon ",V
Owner Name: . ......P..........`'�P. ................ .......................................................................................
.,,,-,.- ---,
FacilityContact: .Title: ................................................................ Phone No: .......................................4...........
MailingAddress: ..................................................................................................................... ...................................................................................... ............................................
Onsite Representative: j-;% C Q V Integrator: .� �r,7t �r ''-,,
..... ........... . ................................................... . .................. .......... �....
Certified Operator:................................................... ............................................................. Operator Certification Number:...............
Location of Farm:
AL:
.... .... .......................... .................................................... __..... .................. ......................_._..._._.. ... .......... ..
Latitude Longitude
Design Current - - Design Current Design Current
Swine Capacity Population Poultry -'—Capacity Population Cattle Capacity Population
❑Wean to Feeder ❑Layer ❑Dairy
❑Feeder to Finish ❑Non-Layer I I 11jNon-Dairyl
❑Farrow to Wean
" ❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity
❑Gilts.
❑Boars Total SSLW
- -. Number of Lagoons 2 LL ❑Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
:..Holding Ponds I Solid Traps ❑No Liquid Waste Management System
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes ❑No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ❑No
b- If discharge is observed,did it reach Water of the State?(If ycs, notify DWQ) ❑Yes ❑No
c. If discharge is observed.what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'?Qf ycs, notify DWQ) ❑ Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage) less than adequate? ElSpillway Yes ElNo
Structure I Structure 2 Structure 3 Structure 4 Stntcture 5 Structure 6
Identifier: Z
Freeboard(inches): ......... .................................... ................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/trees, severe erosion, [:] Yes ❑ No
seepage.etc.)
3/23/99 Continued on buck

Facility Nub»ber: 31 — 1 2 t•t Date(if Inspection 2 8 2ao0
6. Ante*there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑No
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7, Do any of the structures need maintenance/improvement? ❑Yes ❑No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes ❑No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid lever
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 ❑Yes ❑No
12. 'Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes ❑No
14. a)Does the facility lack adequate acreage for Iand application? ❑Yes ❑No
b) Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? ❑ Yes ❑No
15. Does the receiving crop need improvement? ❑Yes ❑No
16. Is there a Iack of adequate waste application equipment? ❑Yes ❑No
Required Records&Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes ❑No
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) ❑Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes 19 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
0: 10 yiolatiaris'or defciei3cie5-were po(ed•during phis visit: Yoir will reeeiye Rio further.
corres otidence ab' ,f this:visit
Comments(refer to questton#) ExpIain any YES answers and/or any recommendations or any other comments
Use drawingss of fadU to better es Iatn sttuations�M use addihonal a es as necessa }•
Tns Crf Cc)nGIVC4.=tt rn e1cS h;ebh 7rrce6*A,,4
.. level
4. Lc1)oprj 1ellcIs s1,o /y( 6e oc,,cfeo� i►�t q rc 1!�;O an-s;bt e, v,vtcr
C,rA e .rove✓ }�ry,l a-F AC+"oP^ rec U ,-e�eK-�r ono( ;-1S4rvc4le_4 4t q
le, rubvK :A4ee4 .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
3/23/99
f

N_
13 Division of Soil_;i6&Wat6'.C6 tion-,Operation Revieii
. . Division of Soil and-Watert-C6n§eton-.
C6mpliance,9!specti
OP
�bjvision.of Wa-ti-i'Quality., pinpliance lnspe:ctiop
--------, 0 Other Agency Operation Revi t,eww�'
MYRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number t Date of Inspection h
Time of Inspection 24 hr.(hh:mm)
OfTermitted [3 Certified [3 Conditionally Certified [3 Registered JE3 Not Oper;tional Date Last Operated: ..........................
FarmName: .... County: ........................................... . .......................................... .......................
Owner Name: ..................... ............ Phone No:
FacilityContact: ...............................................................................Title: ................................................................ Phone No: ...................................................
MailingAddress: ..................................................................................................................... .................................................................................... ..........................
Onsite Representative: ............................................................................. Integrator: A- ..................................................
Certified Operator:................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
............................................................................................................................................................................................................................................................
....................................................... ..........................................I............................................................ ...................................................................................
Latitude Longitude
i Current Design, 7'Curre-nt
Design. u. .. ... Current,` D
- -- ------- Design
Cattle Capacity P60 Capacity
-,-.'S*iihe - . roultry-
Populati6 apacity P60ulation tilatioh,'.
-71[]Wean to Feeder ❑Layer ❑Dairy
5I ]Feeder to Finish -Layer ID Non-Dairy
1[]Non
-----------------
[71 Farrow to Wean _
El Farrow to Feeder ID Other I
ID Farrow to Finish
-------- �--Total Design'Ca t
y
Gilts,
S
❑Boars Total' SLO
"Number-G of Lagoons ID Subsurface Drains Present-
agoo-Area JE1 Spray Field Area
Holding€Ponds'/Solid Traps ❑No Liquid Waste Management System
ry _j
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? E]Yes No
Discharge originated at: El Lagoon []Spray Field D Other'
a. If discharge is observed, was the conveyance man-made? E]Yes E]No
b. If discharge is observed,did it reach Water of the State?(If yes, notify DWQ) 0 Yes EI 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) E]Yes E]No
past discharge from any part of the operation? 0 Yes 0
5k,
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?' El Yes b0o
� '�n & Treatment
_�= -etie�
4. Is storage capacity (freeboard plus storm storage)less than adequate? [I Spillway 0 Yes �io
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
el I
Freeboard(inches): ............2��k.............. ............"a....4........... .................................... ................................... ................................... ..................................
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, El Yes �10
seepage,etc.)
3/23/99 Continued on back

Facilify Number: — 2 Date of Inspection
Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes O'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Ayes ❑No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes WNo
Waste application
10. Are there any buffers that need maintenance/improvement? ❑Yes XNo
11. Is there eviden a of over application? ❑Excessive Ponding ❑ PAN ❑ Yes &rNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑Yes XNo
14, a)Does the facility lack adequate acreage for land application? ❑Yes JVNo
b)Does the facility need a wettable acre determination? ❑Yes ❑No
c)This facility is pended for a wettable acre determination? Oyes ❑No
15. Does the receiving crop need improvement? XYes ❑No
16. Is there a lack of adequate waste application equipment? ❑Yes "No
Required Records &Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes J)j(No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes Wo
19. Does record keeping need improvement?(ie/irrigation, freeboard, waste analysis&soil sample reports) Yes ❑No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes "No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes [)(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application) ❑Yes allo
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes allo
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
. 46. Uel,cle.hdL-9 were h6fed-d4 ifig this.visit'.Y.o12 WRI-f&44Vt't'i0 ll'tllel'
cor'res oridenee_a�aut this:visit. : : . : : : :
Comments(refer"toiquestion#)::Explain any YES answers and/or any rec©ii . endations-or-anyWother`comments:-
_ _
Use drawings of facility to better explain situations..(use additional pages as necessary)
TI
t -A , . t
r
Reviewer/InspectorNames _
Di__
�3,q:
Reviewer/Inspector Signature: Date:
r—
3/23/99

` FaciMy Number: j�Lj Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours'? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes ®No
roads,building structure, and/or public property) '\
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance prublems with the ventilation fan(s) noted'? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters,etc.) ❑Yes WNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'? ❑Yes &No
ddrtionah omments and/orDrawings:
5VXI�- t..�4
�7
CC,L- bA- -�'7�'�U 4%'�.5,
�Ql \5`--ka 30 erp� !1�`
`61� C C
<��t- ice 5� � K��-� �QL- �
3/23/99

Division of Soil and Water Conservation
�] ❑Other Agency �� z
.� Division of Water Quality
113 Routine O Complaint O Follow-up of DWQ inspection O 1'ollow-u of DSWC review O Other
Facility Number
Date of Inspection y lz
t
Time of Inspection 1i r 24 hr.(hh:mm)
Registered. P Certified (]Applied for Permit ®Permitted JE3 Not O erationa! I Date Last Operated!
Farm Name: JMm ......Lvzt<ia.Ut ........ r.:4-...U............ Count
........................ y�........... I. . ..................................... .......................
Owner Name:.....................................k-w^..-----•....... ............................ Phone No: .... ..........................................
FacilityContact: ................................ .Title: ........ Phone No:............................................. ........................................................ ...................................................
MailingAddress. .......... 1.34........$. 14w ....4k..................................................... ...........WA.(.(X!L)....Nc....................................... ..z:tq& ........
Onsite Representative:.....,..... .r�x,........,�G.usl � ti..................... ............. Integrator:
L/q a ...........................................................
Certified Operator................................................... .....---................----..... ..... Operator Certification Number..................................... ..... ............
Location of Farm:
L...IY ilt.l.....�tF.G. . ..o .
..................................................................... ................... ............................................ t
Latitude �•���" Longitude �• ��
_ a` ,Design "';,Current Design Current; ;,, ,Design Current ;`
S neu „ Capacit Population Poultry Capacity Population Cattle Capac►ty Population ;
5.❑Wean to Feeder ❑Layer El Dairy
Feeder to Finish �1&4 ❑Non-Layer ❑Non-Dairyl 1r'
❑Farrow to Wean 777
❑Other
❑Farrow to Feeder u
❑Farrow to FinishTotal Design Capacity
❑Gilts
❑Boars Totaf sn
....... ..__ _
W
:
Number of Lagofsns/H(ilding Ponds 0 ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
r _ EllNo Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑Yes [ANo
2. Is any discharge observed from any part of the operation? ❑Yes P No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑Yes T 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 [P No
3. Is there evidence of past discharge from any part of the operation? ❑Yes EP No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes [ No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes No
maintenance/improvement?
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
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes 91 No
Structures La oons Ioldin Ponds Flush Pits etc.
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes t,_jV o
Structure L Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ) 2
... ................................... .................................... ................................... ................................... ...................................
Freeboard(ft): ..........1................... ...............Z3...........: ...............
.................... .................................... .................................... ....................................
10. Is seepage observed from any of the structures? ❑Yes CkNo
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 UNo
Waste Application
14. Is there physical evidence of over application? ❑Yes ,®No
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
15. Crop type .......... ......................IVV L�A....t��fh ».......................
�
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes [�No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes ®No
18. Does the receiving crop need improvement? [&Yes ❑ No
19. Is there a lack of available waste application equipment? ❑Yes [ANo
20. Does facility require a follow-up visit by same agency? ['B Yes ❑No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes M No
22. Does record keeping need improvement? [4 Yes ❑No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes [l No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes [A No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑Yes [RNo
0-No:violations•or. dericiencies.werenoted-during this.visit.-You:vvill recei've•no further
OtrespQndence about this:visit. : : : .
Co�mWrefer ti►qun E�rpta�ri any YES answers adfor any imme�ntlat�o�gs nr€any ether comments
=Use dirawin of fa l�ty ttt bettrx exgla�n srtuabohs."(use addtgt�naI=pages as necessary} FF
4
IM
�.i u? .,Re gym&. "'"'°'°°_-...<...x..�,�s ` x yak
12-. l ka]iOti Gov :hover �j,t1` 6+J4t1 Dp� 1Atg00lh_ i+Z C.ko"IV 4, MUd T vt,St'r0L4- 1),,tzt A��1 Qh-
Aa:yor, -a- � '(`Q()%kaJ�O ,"W4 90,- - �l�pCZ CSC �0.� ,k -,"w �a_ Y!�l el��W• L J
►e. tP-n-,,Jo` r*u%V L Cev,E c� coa�,4"twe_ 6x.4.s�a,..t �,-� �.� Sc t 4 kky-
�, ocs til t e` �?y s(u+y� L (J L
1 Z, tin l r4CO+QJ S S�OIJ`�l �P� �J� 1 5P( IUi l JB+J"� G Sl h� Thsi CGYytLL AC.�` .e
Av" 6 r- --kti-- 1�A rvO�Jtt�t W o'j
f�� t+�aele.e} iiv.lti_ � t� �-tf�ccrs) `e
�r e +off '�na_ '�►�0 tti. na 3 �►WJ1j 64.r 1 V4kW MO11�' OOi� dvi 5Yv% 'E 7
�e `9� H,
Reviewer/Inspector Name ' RZ
,vals
Reviewer/Inspector Signature: Date:

g ❑DSWQM&HAl Feedlot Operatloa Reviewer
�� �k '�.DWQ�Animal Feedlot Operatlon�Slte InspeCt>lonf �� >�� ��.� �, �
Routine O Com laint O Follow-up of DWQ inspection O Follow-uR of DSWC review O Other
Date of Inspection
Facility Number I
Time of Inspection 24 hr.(hh:mm)
Total Time (in fraction of hours
Farm Status: ❑Registered ❑Applied for Permit (ex:I 25 for 1 hr 15 min))Spent on Review E=
Certified ❑Permitted or Inspection includes travel and rocessin
❑Not Operational Date Last Operated: ......_................
FarmName: /:::.11—....—.t Z.----.--.--..--.-.- County: ... .. ___. ....._. ... ...,�... . .._..
Land Owner Name:.t -� AY1... YC1At .. ..... ............................ Phone No: ��j .. :. .
Facility Conetact: J ---.—---- Title: . , Phone No:
Mailing Address: . .. `t_..5�.. �..._.HTe%►t. .............. .. W. 1 ... . ....
Onsite Representative: ... �Pu�... �....__....__..... ....__.._._....... Integrator:..._... _ ...._. ...._. ...._....._ ..... ..
Certified Operator: .,... Sta 44a1i,.... ..... ..... .._. ,.., Operator Certification Number: � .
Location of Farm:
_........ _ . .... .._ . . ...E]r` •.... cam.. .. ...� .._ $.....{ �Z�..... �.... .taci. �S _..l. ........ 4
h..... !.XJsF�..... .... 1. ....W..`4:4_ S[�..� .�:_.. �a�rn�.... ..0±...96LAUL... ..`F 1 ,.._. ..... ....w..... . �y
Latitude ®•®1 u Longitude ©• $O Z S
Type of Operation and Design Capacity
tr
S�wiae Des gn Current '; Design Cui•�ent Design tCurren
act aPo ulation Poultry Ca aci Po`t latian Cattle ••�Ca ci ;_3Pa Mahon.
!]Wean to Feeder y10 Layer ❑Da'
Feeder to Finish 3 ❑Non-La er ❑Non-Dairy
Farrow to Wean
Farrow to Feeder sign Capaetty 36 2 M'
Farrow to Finish _ t tall Lys a0
� t
❑Other T ,u
"Number uf'I;agoonsn/Holding Ponds f ❑Subsurface Drains Present
2F�u
Lag y Fi Area❑ oon Area ❑Spra eld
General
1. Are there any buffers that need maintenance/improvement? ❑Yes RNo
2. Is any discharge observed from any part of the operation? ❑Yes ONo
Discharge originated at: ❑Lagoon ❑Spray field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes 10 No
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) ❑Yes WNo
c. If discharge is observed,what is the estimated flow in gaUrnin?
d. Does discharge bypass a lagoon system?(if yes,notify DWQ) ❑Yes Wo
3. Is there evidence of past discharge from any part of the operation? ❑Yes PyNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes No
4/30/97 maintenancelimprovement?
Continued on back

Facility Number: ....3(......—..� . ..
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 No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes f9 No
Freeboard(ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure S 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 No
Waste Application
14. Is there physical evidence of over application? ❑Yes No
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
....
15. Crap type . .......�.._ i1_...> .. ....__.........._..tC�s ....._ ........._..----...... ..^...._.......—._.._
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes P No
18. Does the receiving crop need improvement? Yes ❑No
19. Is there a lack of available waste application equipment? ❑Yes Jj3 No
20. Does facility require a follow-up visit by same agency? ❑Yes WNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes allo
for Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes $)No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes J9 No
24. Does record keeping need improvement? ❑Yes No
Comments refer to'° estion Ex'lam ari` YES answers and/or any.recommendations qr an other comments
Use diawings,of facility to better explain situations:(use,addttronal pages as necessary}
5' fr,c Lexv,,Y Veil oh Vid%4... If !�_ 1 Q
IX. Er,as,ee CJk at- ir.r�,tr` to or, WkUs S6Uja rye Yi f L d mwed►Pj. 56,)[J
rwwer)- II
ID
Reviewer/Inspector Name n
Reviewer/Inspector Signature: Date: {
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

F. : m❑,DSWCAn1ma1 Feedlot Operation Review x
'� ]dam i F ,b > -E
- DWQ:Animal Feedlot Qperatlon S1teInspecttonr "
a .. 0—
Gk � x
Routine Q Complaint 0 Follow-up of DW2 inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection !n 7
Facility Number f Z
Time of Inspection 24 hr.(hh:mm)
Total Time(in fraction of hours
Farm Status: Registered [I Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
❑Certified ❑Permitted or Inspection includes travel and processing)
❑Not Operational Date Last Operated: ......_.... _..... _.... _.............. ....._..... W...._._....._...... ....__...._ ...... .......................
Farm Name: .....� M --�G fl�> .... �m. .-,-..._ .... ... .. ... County:_ lu(L ..�_ .... . _...._....._.....�....
Land Owner Name: .`. �t1,SQ�.I... _... 11 t .. ..... Phone No:
Facility Conctact: ...�1�, .�l�ut d,u� _.... -_. Title: Phone No: .. .
Mailing Address:__.. `� S mil✓... rl� "t.�.......... .:..__.._._...... ....�4�A��i{P. *.I�l ._.... ( .... -.. _.... _..........._ ....
Onsite Representative: ..... ya,. �..._...._. Integrator:.-
. ..._-.....--...._W.....�....-. Int ator:.- __...._�...._...... ........ ..... ....tct.(st.ta,._. ..._ .
Certified Operator: ....a�A SDx� ... 3 _ .. Operator Certification Number:
Location of Farm:
so
Latitude �•®�t--=—F—�K Longitude ( 0
Type of Operation and Design Capacity
«Design Citrrenfg DestgNuCuixentY Design Current
Swtoe Pol CattleP,O ulatlon
actPo ulahon ?' E.. .�Ca aci o`ulatton't Ca act
❑Wean to Feeder ❑Layer ❑Dairy
®Feeder to Finish 6 7 ❑Non-La er rf ❑Non-Dairy
Farrow to Wean 17
� � `
Farrow to FeederRo
�
Total Design Capacity � �
Farrow to Finish
i f 7 � A €
a TotaltSSLW
�0 Other
Number ofkLagoonsl Holding Ponds ❑Subsurface Drains Present
ri a ❑Lagoon Area , ❑Spray Field Area E� ,_._� a .�.; �., 3„�•� ,.
General
1. Are there any buffers that need maintenance/improvement? ❑Yes 19 No
2. Is any discharge observed from any part of the operation? ❑Yes ja No
Discharge originated at: ❑Lagoon ❑Spray field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes toNo
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) ❑Yes [RNo
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 [BNo
3. Is there evidence of past discharge from any part of the operation? ❑Yes ®No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes 19 No
5. Does any part of the waste management system(other than lagoons/holding ponds)require Q9 Yes ❑No
maintenance/improvement?
4/30/97 Continued on back

Facility Number: . �.... . «i
. '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 PNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes JR No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity(freeboard plus storm storage) less than adequate? ❑Yes 0 No
Freeboard(ft): Structure 1 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 No
Waste Application
14. Is there physical evidence of over application? ❑Yes No
(If in excess of WMP,or runoff entering waters of the State,notify DWQ) I`
15. Crop type ................ { �.. ?�21fI 1 ....................................... t.W.3n..............._..............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes &]No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes ja No
18. Does the receiving crop need improvement? ❑Yes 5&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 Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes JO No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ja No
24. Does record keeping need improvement? ❑Yes ®No
Comments(refer to question'. Explain'#ny YES answers`and/or.any recommendations or any,other comments:
Use drawings.of facility,,to better explainssituations r{use additional pages as necessary} 3 '
Reviewer/Inspector Name
Reviewer/Inspector Signature: 1 f Date:
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires immediate Attention
Facility Number: -
7ii
SITE VISITATION RECORD
DATE: n , 1995
Owner: Ta.so-I c „���, -— Farm Name: C V
County: 0�p I
Agent Visiting Site: o„1 6-1 Phone: qI o —.;zA —.21�2-6
Operator: Phone:
On Site Representative: Phone:
Physical Address: _ O� Sf2 r a,�WY,, .t L_2
Mailing Address:
Type of Operation: Swine Poultry Cattle
Design Capacity: Ar) Number of Animals on Site: 3 6
Latitude: o Longitude:
Type of Inspection: Ground)_ Aerial
Circle Yes or No
Does the Animal Waste Lagoon bave sufficient freeboard of 1 Foot+ 25 year 24 hour storm event
(approximately I Foot+7 inches) Yes or No Actual Freeboard: 1 Feet _Inches
For facilities with more than one lagoon,please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments: _
s
Fax to [phone] Signature of Agent

Site Requires Immediate Attention:
Facility No. 3 1 Z f.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANrMAL FEEDLOT OPERATION4 SITE VISITATION RECORD
DATE: Z , 1995
` ime: II
Farm Name/Owner: /�'�ON I/ �✓�9`I�� hC`� r
Mailing Address: r• J �~ �
County:
Integrator. % [/i�f��T Gi Phone: �iPl TZ7
On Site Representative: Phone: rS�
Physical Address/Location: 6AID 0)
Type of Operation: Swine Poultry Cattle 2
Design Capacity: �J 7— �[JP� Number of Animals on Site:
DEM Certific Lion l!Number: ACE DEM mortification Number: ACNEW
Latitude: 'f�' l�P Longitude:_7? ° S0 ' ZI " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have ffcient freeboard of 1 Foot +25 year 24 hour storm event
(approximately 1 Foot+ 7 inche Yes No Actual Freeboard:�`�Ft. C� inches
• Was any seepage observed from t e agoon(s)? Yes r N Was any erosion observed? Yes No
Is adequate Iand available for spray? Yes or No Is the cA; 7 ('
r crop adequate? Ye orNo
Crop(s) being utilized: ^ ���5 ��� �f•
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No If Yes,Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments:
,o
I
Inspector Name Si ature
cc. Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention' 0
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: v - , 1995
Time: f I U
Farm Name/Owner. G CO-
U
Mailing Address:
County: 1� S
Integrator: o Phone:
On Site Representative: n, CA— Phone:
Physical Address/Location: A I- `i
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: "- 3 C c�, cf3 Number of Animals on Site: 3 6 00
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: _" A-C ' _ g " Longitude: --12-° S o ' �" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon havesqfficient freeboard of I Foot +25 year 24 hour storm event
(approximately 1 Foot+ 7 inche Yes r No- Actual Freeboard: �Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o oNo Was any erosion observed? Yes No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? te 9or No
_ 100 Feet from Wells? es r
Is the animal waste stockpiled within 10Q Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or Vo If Yes, Please Explain.
Does the facility maintain adequate waste management records (v es of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o No
Additional Comments:
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

• - '`dam�....-�.
I'
REGISTRATION FORM FOR ANIMAL FEEDLOT OPERATIONS '-`—
Department of Environment, Health and Natural Resources
Division of Environmental Management
Water Quality Section
If the animal waste management system for your feedlot'O"V(;zatzo •
is designed to serve more than or equal to 100 head of caE ' , 75
horses, 250 swine, 1, 000 sheep, or 30, 000 birds that are served
by a liquid waste system, then this form must be filled out and
mailed by December 31, 1993 pursuant to 15A NCAC 2H. 0217 (c) in
order to be deemed permitted by DEM. Please print clearly.
Farm Name: Jason Cavenaugh
Route 2 Box 146-A
Wallace, NC 28466
Duplintt County 919-285-2889
Owner(s) Name: V. ASoh ln= avenuuj� _
Manager(s) Name: S d M C --
Lessee Name• Turn left onto SR 1148 (Rosemary Rd); go
about 5.0 miles, cross NC it to the SR
1947 (Island Creek Rd) and SR 1953
Farm Location (Be as specific as possible: to sture Branch Rd)intersectionwith sNCi41;£turn wLt.SR onto
direction, mllep 5 , etc. ) : 14r- ) O-Igc C�NC 41 d go 2.5 miles then turn Rt. onto
l
(L a �^ �SR 1827 (Deep Bottom Rd); follow SR 1827
for 2.0 miles, turn Rt. onto SR 1980
ClA (Stokestown Rd) and go 0.1 miles, turn
Lt. onto SR 1979 (Rock Rd) and go 0.5
mile to farm complex entrance. (NOTE: CV2
Will be set of houses straight ahead a
CVG Will be houses to Lt.j (TT=19 min.;
TD=13 miles)
Latitude/Longitude if known: QBSP # 24-026-25-05
Design capacity of animal waste management system (Number and
type of confined animal (s) : 3,(!71- _
Average animal population on the f4rm. (Number and type of
animal (s) raised) : 3� �12. ` IrinlSl�i,�� c�¢S
Year Production Began: 9 ASCS Tract No. : 7
Type of Waste Management System Used•
S J2 12'r-j af-�� �
Acres Available for Land Ap lication of Waste: 3c-'rr5
Owner(s) Signatures) : Date:
Date:
(Bob Silbrey, Serviceman)

Stcte of North Ccrolina
Department of Environment,
Health and Ncturci Resources
Division cr" Envirer.mentci i'rlcr.cgement Y _
James B. Hunt,Jr., Governor
Jonathan B. Howes, secretary E-= I---]
A. Preston Howard,Jr., P. Director
February 17, 1994
Jason Cavenaugh
Rt 2 Box 146A
Wallace INC 28466
Dear Mr. Cavenaugh:
This is to inform you that your completed registration form required by the recently
modified nondi.scharge rule has been received by the Division of Environmental Management
(DEM), Water Quality Section.
On December 10, 1992 the Environmental Management Commission adopted a water
quality rule which governs animal waste management systems. The goal of the rule is for
animal operations to be managed such that animal waste is not discharged to surface waters
of the state. The rule allows animal waste systems to be "deemed permitted" if certain
minimum criteria are met (15A NCAC 2H .0217). By submitting this registration you have
met one of the criteria for being deemed permitted.
We would like to remind you that existing feedlots which meet the size thresholds
listed in the rule, and any new or expanded feedlots constructed between February 1, 1993
and December 31, 1993 must submit a signed certification form (copy enclosed) to DEM by
December 31. 1997. New or expanded feedlots constructed after December 31, 1993 must
obtain signed certification before animals are stocked on the farm. Certification of an
approved animal waste management plan can be obtained after the Soil and Water
Conservation Commission adopts rules later this year.
We appreciate you providing us with this information. If you have any question about
the new nondischarge rule, please contact David Harding at [phone].
Sincerely,
Steve Tedder, Chief
enc: Water Quality Section
P.O.Box 29535,Raleigh,North Carolina 276264)535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/10%}past-consumer paper

RECIST ATION .-.r:`<. "OR -ems=MAL - EEDLOT OPERATIONS 4 •
Deparrment oT Environment, ANIMAL
h and Natural Resourc-
Division of Environmental Management
Water Quality Section
the animal waste management system for your feedlot operation is
designed to serve more than or equal to 100 head of cattle, 75
horses, 250 swine, 1 , 000 sheep, or 30, 000 ,Girds i at are served by
a liquid waste system, then this form must be filled out and mailed
by December 11, 1993 nursuanz to 15A NCAC 2?: . 0217 (c) in order to be
deemed permitted by DEM. Please print clearly .
Farm Name :- ��, A,5 e ,— C d Ve n / Li C L
Mailing Address : -P-, -+ L;Cy, 1L16 -jA I.-JA/Jl le
7,D
County : I ' Phone No.�,��"LZ-A�rl
Owner (s) Name . Ca'le1tAc.4G�
Manager (s) Name: _� �sa C /� �c'n ��t
Lessee Name : --- _
Farm Location (Be as specific as possible : road names, direction,
milepost, etc . ) 4 k�. 1 �` h:'a 2. n,;ie� fra_ 7L fcC
f—
t ,,- o cngss Civer rQcvT
4ke 5. F -i nd B
LaL_ade/Longitude if :mown
Design c apac_zy of animal Waste management system (Number and type
zf confined animai (s) ) Ar..,'s .'.-� c F—lo o r• ,. , -FL /I'IN 1 -I t"o►S.
3i 6 `72 A cr r
Average animal population on the farm (Number and type of animal (s)
r wised) . 6J oc
Year Production Began: 42 ASCS Tract No. : T I
Type of Waste Management System Used: 1t lae
.acres Available for Land Application of Waste : .33
owner (s) Signature (s) DATE : 12 - 7 -553
a.t DATE Z -Z7- S3
3 �- b

. State of North Carolina
Department of Environment,
• Health and Natural' Resources + v
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary ED E:-= "]**V
A. Preston Howard,Jr., P.E., Director
March 21, 1994
Jason Cavenaugh
Rt 2, Box 146A
Wallace NC 28466
Dear Mr. Cavenaugh:
This is to inform you that your completed registration form required by the recently
modified nondischarge rule has been received by the Division of Environmental Management
(DEM), Water Quality Section.
On December 10, 1992 the Environmental Management Commission adopted a water
quality rule which governs animal waste management systems. The goal of the rule is for animal
operations to be managed such that animal waste is not discharged to surface waters of the state.
The rule allows animal waste systems to be "deemed permitted" if certain minimum criteria are
met (15A NCAC 2H .0217). By submitting this registration you have met one of the criteria for
being deemed permitted.
We would like to remind you that existing feedlots which meet the size thresholds listed
in the rule, and any new or expanded feedlots constructed between February 1, 1993 and
December 31, 1993 must submit a signed certification form (copy enclosed) to DEM by
December 31, 1997. New or expanded feedlots constructed after December 31, 1993 must
obtain signed certification before animals are stocked on the farm. Certification of an
approved animal waste management plan can be obtained after the Soil and Water Conservation
Commission adopts rules later this year.
We appreciate you providing us with this information. If you have any question about
the new nondischarge rule, please contact David Harding at [phone],
Sincerely,.
/-n Steve Tedder, Chief
enc: Water Quality Section
P.O. Box 29535,Raleigh,Forth Carorina 27626.0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%recycled/10%post-consumer paper

Site Requires Immediate Attention: No
Facility No_ _jr)
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO?NP SITE VISITATION RECORD
DATE: , 1995
SVe4_xy4
Farm Name/Owner: 4 ew
Mailing Address: _ � J _ G
County:
Integrator. � !/�/� Phone:
On Site Representative: '14,100
/g" Phone: S 5" 9
Physical Address/Location: / r 15-W OF S7-A -t
Type of Operation: Swine Poultry Cattle
Design Capacity: , '& ) Number of Animals on Site:
DEM Certification Number: ACE DEM ertification Number: ACNEW
Latitude: a' Longitude: -7? ° SA '3L" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot +25 year 24 hour storm event
(approximately I Foot+ 7 inches • Yes r No. Actual Freeboard:*)- Ft. Inche
. Was any seepage observed from the lagoon(s)? Yes r No as any erosion observed? Yes r No
Is adequate land available for spray? 2Yes or No Isjhe cover crop adequate? Yes or No
Crop(s) being utilized: _ � -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling _ Ye r No
r, 100 Feet from Wells es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25, Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes r No, If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes No
Additional Comments: - &a&*Y1�'�CA P-) — 1 _� ��l_ ��_
i s
Inspector Name VS' ature"
cc: Facility Assessment Unit Use :attachments if Needed.

O ERRTIOH BRAM_CH - WQ Fax:[phone] Jul 20 '95 12:57 R. 07/09
Site Req'1j.cCs blvil_;diate At'=IiOn
T acilit a t�f umber: 13!11J__V
SITE VISITATION RECORD
i
QVJIIez: Farm Name: -
J
County:
V
Agent Visiting Site: J-I0a i h n _ Phone: -, q f 122�
Operator: - Pliotze:
On Site Represesitativt.- Phone: _--
Physical Address:,
Mailing Address:
Type of Operation: Swine_ Poultzy Lattia �—
n�
Design Capacity: 36 ,L.;- Number of A.ni.rnals on Site..
Latitude: 4 Lentmude:
. Type of Inspection., Ground '�Y Aerial
Circle Yes or No
Does [he Animal Waste Lagoon have sufficient freeboard of 1 Foot+25 year 24 hour stozm event
(approximately I Foot+7 inches) Yes or No Actui�l Freeboard: )__ Feet L Inches
For facilitit:s with nsoze tan one lagoon, please address the other I-goons' freeboard Tinder the
cotnrnents section.
Was any se-patre observed from old lagoo'n(W Yes or No Was there erosion of the dam?: Yes or No
Is adequate'land available for land application? Yes or No Is the cover ,,rep adequate? Yes or No
Pax to (9199 7IS_3530' - �Si�niature ofAdcnt