310133_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Ruai

J
�sion of Water Resources
Faciility Number �� - / Q Division f Soil an Water Conservation
� O#her Ageacy
Type of Visit: Co nce Inspection 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: Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: J4� a 7 �+^'� �' l�"�� integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
Wet Pouliry
er
RIN
Design
Capacity
Current
Pop.
Design Current
Eattle Capacity Pop.
Dai Cow
can to Feeder
on -La er
Dairy Calf
Feeder to Finish
G 2 I
Dr, P,oui
Layers
Design
Ca aci
Current
P,o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
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
❑ 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
❑ ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] YesE�N/
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: -t 3 jDate of inspection: �7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o Q 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:
Spillway?:
Designed Freeboard (in): C'
Observed Freeboard (in): b
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental rest, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Eff"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
D Yes No ❑ NA
D NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes O '� - ❑ 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 N NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ,' No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall El 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 yo ❑NA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yeso ❑ NA ❑ NE
Page 2 of 3
214.12015 Continued

Facili Number: Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E]-ITo=NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-goQ 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 Ej No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No FrNA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA [] NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
Ion ❑ NA ❑ NE
e'No ❑ NA ❑ NE
�No❑ NA ❑ NE
Comments (refer to question #). Explain any YES answers_and/or any additional recommendations orany other comments
Use drawings of facility -to better..explain situations (use additional.pages.as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
(2, —t q
e,
0
Phone: , 011 1 `-1 PLi
Date: b 1, �
214120l

Type of Visit: p Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine Q Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: NA'�q� + �� ( Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: 1 l Ips 9
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Crattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Z
D . P,©uItt�
Layers
Design
C•.a acit
Current
P,o ,
Dairy Heifer
Dry Cow
on -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any, part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes CZ /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
[:]Yes Vr;c
❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
Page l of 21412015 Continued

Watility Number: jDate of Ins ectiom
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1� Structure 2
Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[5 No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [%No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PKNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require 0 Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I �f No ❑ NA ❑ NE
maintenance or improvement? TTT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [71/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZI o
❑ 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
W�40
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�- o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 ❑ 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: 2 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�] o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
VNo [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ZNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ZNO ❑ 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
&3 o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[No ❑ NA ❑ NE
Comments {refer to question ft. Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of -facility to better explain situations (use additional pages as necessary).
N�o p6-A -uss PtAs-r t
Sw0 6-C
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
�c-wtoveD
Date:
0

(Type of Visit: Q Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral 0 Emergency O Other Q Denied Access
Date of Visit: j,� Arrival Time: E[Z= Departure Time: j County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: Ljdny lei 61L1_Eu Integrator:
Certified Operator: Certification Number: ' ! 6 S
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capaclty Pop.
Layer
E]
Design C«urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C*urrent
Dr. P,oult . Ca aci P,o ,
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
-is,
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
[:]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
❑ o ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[—]Yes
LJ N❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
C No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facilitv Number: Date of Inspection: 1n A I'r
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 VNo ❑ 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 E�No ❑ NA ❑ NE -
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 40 ❑ 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [-]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EZ/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
❑ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
90
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
``77``'''' �No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[3Yes
� o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[7o
❑ 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 IdNo ❑ 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? El Yes �] o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: 10 ji
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes k �J l� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C2rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes [I/No ❑ NA ❑ NE
❑ Yes [Z/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
CNo ❑NA ❑NE
No ❑NA ❑NE
P/No ❑ NA ❑ NE
E/No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatuw
Page 3 of 3
Phone:N1 1 1 G
Date: C / 45
21412015

(Type of Visit: m Co7liance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance - I
Reason for Visit: Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: E>L)pV Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: jo- ISCA—T N lA iS i t Ial,L-w Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Ft]Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I INon-Layer
I
EJ
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
MQ7e7sign Current
D . P,oul Ca aci_ P,o ,
Layers
Dry Cow
Non -Da
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Ot
Other
Turke s
urkey Poults
Other
Discharges and, Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No [] NA ❑ NE
❑ YesF3/No ❑ NA ❑ NE
[—]Yes,pAlo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes o
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
DNA ❑ NE
❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
0
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No[:]
❑ 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/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 environmenta hreat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
/ No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes P3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes rN9❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 04109
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes &N�o
❑ NA
❑ NE
Re[tuired Records & Documents
19. Did the facility fail to have the 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 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 E2eNo ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

l
Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA ❑ NE
gNo
25..Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ 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
N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
,--,�
L-�J 1Ye ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time the inspection did the facility
❑ Yes
NA ❑ NE
of pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ 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
ZNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesrNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Comments (refer to question #): Explain any YES.answers and/or any additional recommendations 6f any,other comments .
Use drawings of facility to better explain situations (use additional ones as necessary). � Y.: ' `
• .
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
N&N-K.CcPhon 41b
Date:
4

Type of Visit: Q) Co
pliance-InspectionQ Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other . 0 Denied Access
Date of Visit: Arrival Time: d O Departure Time: O County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: QQoi s7m. Ara (V�aLLf�(7_ Integrator:
Phone:
Certified Operator: Certification Number: 1 hs 9
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
a r
Wean to Feeder
LEN—on—i'T
Feeder to Finish
Farrow to Wean
Ilry P■i
Farrow to Feeder
Farrow to Finish
Layers
Gilts
Non-L
Boars
Pullets
Other I I IMI (Other
Latitude:
Pouits
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cow
ow
Cy alf
Hy eifer
Cow
Stocker
Feeder
Brood Cow
❑ Yes
No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ ❑ NA ❑ NE
[:]Yes rJ N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page l of 3 21412011 Continued

Facility Number: - Date of inspection: q 45113
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 L Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L11WIV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -6 `-( b
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
ZNo ❑ 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
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
ElYes
yo
❑ 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
C3/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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 [No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ 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? ❑ YesWNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

lFacility Number: 31 - ! _-S 4�_J Lkate of Inspection: y
24. Did the facility fail to calibrate waste application equipment as required by the permit. [:]Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 [ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document []Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [—]Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes WNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [-]Yes O/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 Z ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNol ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑YesNo ❑ NA ❑ NE
Comments (refer to question #): Explain,any YES answers and/or any additional recommendations or any other comments'.
Use drawines of facility to better explain: situations (use additional cages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: j
21412 b I I

Type of Visit: a Co�(pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: C—�'/Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a Arrival Time: Departure Time: ® County: i '10jZAJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: j-1V&TNA-j1J fy 'C+rU-J6 L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: / S4 V f
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
r
NDesign
Cattle
Dai Cow
Current
Capacity Pop.
Wean to Feeder
MLayer
Dairy Calf
Feeder to Finish
3
Daity Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D P,oult Ca aci P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other jLL
Turke s
Turkey Puults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
ONE
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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
VNo
El NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 214,12011 Continued

Facility Number: - 13 Date of Inspection: >;
-tom
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: LA &o6,7i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2—
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[]/ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 ZN90 ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes YNo3 ❑ 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
o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N ❑ 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
N ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[] Yes
o ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ur<0 ❑ 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
" N ❑ 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

Factfity Number: JDate of Inspection: 3Q
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ YesVNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA 0 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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes to
❑ 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? ❑ Yes g 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). -`-
"N
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Q [ Phone/ !l�
Date: - 7/
2/4/2 l

Type of Visit: QoCom``pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Q'Iioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: la Departure Time:E�= County: jaRegion:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
��MM�1 ,// Title: Phone:
Onsite Representative: _Z* *A/ �rt;1,Z.(.tJ'Z_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: -
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Cattle
Dairy Cow
Design C►urcent
Capacity Pop.
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
Dr.. P.oulh. Ca aci P.o .
Layers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turke Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c.. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ N ❑ 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 10 ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of insection: �/
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Z No ❑ NA ❑ NE
[:]No ❑NA ❑NE
Structure 6
[:] Yes ffNo ❑ NA ❑ NE
[-]Yes [/NNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [] No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) — /
9. Does any part of the waste management system other than the waste structures require ❑ Yes EO ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes El"No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ 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):
1-11
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
tJ"`o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[2 o
❑ 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
ErNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
to
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[],IQo
❑ 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 31- Date of Inspection: IS11 Vil
24. Did�the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes Ej No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[frNo
❑ 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
�o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[!j'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.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 2<0 ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
10
❑ NA
❑ NE
[. lo
❑ NA
❑ NE
10
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other, comments ,
Use drawini's of facilitv to better explain situations fuse additional Dares as necessarvl. .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7.3�d
Date: / r1l)
21412011

- Divrston of Water Quality
=i��uniberr 3 � (�3 .�� Q�Dtvtston,.of Soil and Water Conservation � „ � � w
Agency
Type of Visit ,C_,00mpHance inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit tD Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of 'Visit: Arrival Time: (> Departure Time: County: Region: _
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone No:
Onsite Representative: L) �la�a'C�1 _►� r�i ZT-L 1 k&= Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o =' = « Longitude: ❑ c =' = "
Design Current Desi
y
Swine Capacity- Population, Wet Poultry Capa
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
gn - Current-..
city. .Pgpulatton: Cattle
Feeder to Finish
Farrow to Wean ..
❑ a-. Dry Poultry„
a
Farrow to Feeder
`µ ❑ Farrow to Finish
❑ Gilts
Other
❑ Other
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
L l Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Feeder
❑ Beef Brood Co
Plumber.of Structures:n
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [�No ❑ NA ❑ NE
❑Yes
❑No ❑NA
[I NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ElNA
ElNE
❑ Yes
El Yes
i ElNA
[INE
ElYes
7No❑ NA
❑ NE
12128104 Continued

r
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
identifier. (A&�
❑ Yes No
❑ Yes ❑ No
Structure 5
El NA El NE
El NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) �,
6. Are there structures on -site which are not properly addressed and/or managed El 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? El Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes UrNo ❑ 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 [yJ<o ❑ NA ❑ NE
maintenance or improvement?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE ,
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
UKNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
K,
❑ NA
❑NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
go
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any:` recommendations or'any other comments
Use drawings of•facility:to.better explain situations. (use additional pages as necessiWO.
IReviewer/Inspector Name Lj�y Phone:
Reviewer/Inspector Signature: Date:,
Page 2 of 3
12128104

r
• Facility Number: 3 — Date of Inspection 9 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA [INE
El,_(
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes lLJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
INo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
NNo
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,[X
NN
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑Yes
L� No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
el No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 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 coricern?
❑ Yes
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E(No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Cl Yes
E yNo
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Page 3 of 3 12128104

H
E
f Visit gRoutine
mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
n for Visit 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: iTT I Arrival Time: da Departure Time: County:. Lx)'9-N Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: claP)WrW� ,M'SILIM1-- Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 00 a = = it Longitude: Q ° =1 ` =
Design Current Design Current Design Current
�0
Capacity Population Wet Poultry Capacity ]Population Cattle Capacity Population
rFvi
n to Finish
❑ La er
❑ Dai Cow
an to Feeder
❑N-on-Layer
❑ Da' Calf
® Feeder to Finish
'7
❑ DairyHeifer
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑Non -La ers El❑ Pullets Beef Feeder
El Beef Brood Co
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
PE]Gilts
Boars
Other
❑ Turkeys
❑ Turkey Poults
❑ Other
Number o€ 5tructures:
❑ Other
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
❑
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

n
Date of Inspection
Facility Number: —
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: I ACytgnoJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2 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
dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
LI 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
E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L'J No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
F!f-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2/No
El NA
[I NE
17. Does the facility lack adequate acreage for land application?
El Yes
2 No
❑ NA
[INE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[✓] No
❑ NA
❑ NE
Comments (refer to question #} Explain any YES answers and/or any re mm d t n any other comments.
U"se"drawings of facility to better explarn situat►ons„(useaddirional pagesas necessary}: +
Reviewer/InspectorName I i6 ��71 =:� Phone: ld 7K
Reviewer/Inspector Signature: Date: $ A, o
16/66/V4 C.onrinue4

j
Facility Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
❑ Yes R No ❑ NA ❑ NE
❑ Yes LE No ❑ NA ❑ NE
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 I" Rain Inspections El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
,0fNNo
[INA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
rX
L"J
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Er No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes C2'�o ❑ 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
2 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
El Yes
,�/
b 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?
El Yes
,�
L+�J No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
Page 3 of 3 12128104

Type of Visit 0 Cornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 4 t+! ost Arrival Time: ® Departure Time: County: PWir"1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = { = H Longitude: = o = 4 ❑ «
Design Current
mwpociWet Poultry Capacity Population C*attle
Design
Capacity
Currenineulation
Population
❑ Wean to Finish
Wean to Feeder
❑ Layer
❑ Dairy Cow
❑ Non -La er
❑ DairyCalf
Feeder to Finish
39
10
❑ DairyHeifer
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑Non -La ers❑
❑ Beef Feeder
Pullets
❑Beef Brood Co
PEGilts
Boars
❑ Turkeys
❑Turke Poults
❑ Other
Number of Structures:
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
El Yes IJNo ❑NA El NE
❑Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes LI No ❑ NA ❑ NE
❑ Yes El"No ❑ NA ❑ NE
12128104 Continued

.
Facility Number: — Date of Inspection 6
'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: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
,�J/
lLNo ❑ 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
notify DWQ
environmentalth
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ [Iat,
Nc 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
El Yes
�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,�,/
[2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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
dN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
Il I No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
V<O
❑ NA
❑ NE
Reviewer/Inspector Name I �,c AAA - t✓ Phone: — 73
Reviewer/Inspector Signature: Date:
--a-- _F -

'
Facility Number:
Date of Inspection I jig6
�Repuired
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
LI N
[I NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
[IN E
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p [I 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
Q4ual 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?
El Yes
/❑
0<
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�
[I�0NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
L_f No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[-lo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ',"' ❑ NA FINE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�o
El NA
El NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
ElYes
No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2 I 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?
El Yes
��
LEI No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ yes
l[3-Ko
❑ NA
❑ NE
Additional-0jinments and/or Drawings: -t
Page 3 of 3 12128104

[Facility Number 3� 133
Q Division of Water Quality
O Division of Soil and Water Conservation /
O Other Agency V
Type of Visit 0- 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation • 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i0 Arrival Time: a Departure Time: County: Zh/ELM J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: U_. u p_rWP%W L/1 _r_.L't_t.r_
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 0' =' =" Longitude: = n =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish 3 Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
[]_Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: F
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
o
El Yes
,❑
LJ No
❑ NA
❑ NE
❑ Yes
12N0
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 - 1 3 Date of Inspection a !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
21 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: 1PXe_-,,.J I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): k46
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 t eat, 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
W�N,'o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
DX o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
B/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
0 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
,[To
L�`N
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name jo N Phone: g16/'r( — i 3 Ff
Reviewer/Inspector Signature: Date: i d t o

Facility Number: 31 — y Date of Inspection L� Y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VN�c ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste "transfers ❑ 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 ['� N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Zo
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes � ❑ 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
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
7No
❑ 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
L No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
VNo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
I2128104

3t
Type of Visit d ;;Routine
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1 2./23 vS 1 Arrival Time: (OOV Departure Time: County: Region:
Farm Name:
Owner Name:
;Mailing Address:
Phvsical Address:
Owner Email:
Phone:
Facility Contact: *+ Title: Phone No:
Onsite Representative: G*f e.+ 110EDY Integrator:
Certified Operator: &rZA44A ro, I(L-14tJC7y Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = ' = « Longitude: ❑ e =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 136 -72 1 TOOO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non-Layet
Dry Poultry
❑ Layers
ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [](No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — 3 Date of Inspection-3 aS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jNo ❑ 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:ee-
Spillway?:
Designed Freeboard (in): �l
Observed Freeboard (in): 3b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
LI 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
U 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
E�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 El Yes
,�
L! No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
�
10. Are there any required buffers, setbacks, or compliance alternatives that need El[ Yes
No
❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Cl/No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) aea-e-,1pf9 t I -A) S &0 CS'v
13. Soil type(s) 6 A Fa A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[7 o El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[]
Yes
L No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E14 ❑ NA
❑ NE
Comments (refer>to question #) Ezplatn any YESsanswers:and/orany recommendaonsu�or an y outer comments.
Usedrawings of facrhty_to better ezplaan situations '{use addihonal'pagesas5necessary)
FAP- r,,. Lea C1-0� o
OPDATe PNIF1 LS ro 06W VVQ_M5.
Reviewer/Inspector Name Phone: eilb5
Reviewer/Inspector Signature: Date:
.1 WU-r a vnssnweu

Faciliiy Number: 3 F/ 53 Date of Inspection
Ireguired
Records & Documents
Did the facility fail to have Certificate of Coverage & Permit readily available?
19.
❑ Yes
R�D o
❑ NA
[INE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
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
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections D
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
C 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
U(No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L'J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYesgo
o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E4
❑ NA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
ElJ
N
Lo
❑ 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
2rNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
2N
❑
❑
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
NA
NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No �7
El
❑ NE
AdditionalComments and/or Drawings:
12128104

(Type of Visit & Compliance inspection O Operation Review O Lagoon Evaluation
IReasonforVisit P Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 0 Tune: '
Facility Number
Q Not Operational Q Below Threshold
® Permitted MCertifiied O,Conditionally Certified 13 Registered Date Last Operated or Above Threshold: _......._�.....
Farm Name: ...... e 4 rl k `1 v!,%;o a- A.......... rql........._........_............ County: »W...L.f_ r ............... ........ ..... ».
OwnerName: ............................... ........ ........ ..... ............ . .............................. .................... Phone No: .... ......... ............................................
..............._......... .
Mailing Address:
Facility Contact: ......_..... .......... _...� _.._....... Title: ........... _....... _.... ..... ..._...... .. Phone No:..................
Onsite Representative:. �WK✓U`CslG_ !`i!ll �ii P ._............. Integrator -
Certified Operator:._ ..............._ ..... _._ .. _._... ._ ._ ....... Operator Certification Number:. �...._ ..�............_.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude a i «
Discbarees & 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 dischazge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ... -.._. �...._..... �._..2 W.... _w .. _._..w...W .__....... - ,.. . .
Freeboard (inches): Z3
12112103 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste , �i pvLcation
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Lssues
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 ❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
�-tea
NCO (SC�Cr tRi�E.StiOii �� �'�y�x�-� �11EUOF any' 1"ECOmIEteIId8ti0IIS �(1r��if Other�m��n� em m "`�� �`�
�
;Use drawra� of %e�rtg�ta better��laur �t�stac�s. base-a?d'citi�nalp�g�s as necessai7'�<��,� ❑Field Copy ❑Final Notes ���-
Reviewer/Inspector Name
ReviewerAnspector Signature: Date:
12/12103 Continued

Facility Number: 3 f —� Date of inspection
Revuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
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 ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Facility Number Date of Visit: / Z Time:
10 Not Operational 0 Below Threshold
® Permitted B Certified 0 C//onditiTTonally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: �hG h Il /.fGl CZ�i�M County:,0��
Owner Name: Phone No:
Mailing Address:
Facility Contact: Title: one No:
Onsite Representative: Integrator: %em jail/ Jl7z
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0' 06 K Longitude 0' 0` OK
n Current
ROOERPUP51ition
Design Current Design Current
Swine C
Poultry Ca acity P,o ulation Cattle Ca aciiv P,o ulation
❑ Wean to Feeder
❑ Layer ❑Dairy
1 Feeder to Finish Z
❑ Non -Layer ❑ Non-Dai
❑ 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
1E1 S ra Field Area
❑ No Liquid Waste Management System
Holding Potld-S / Solid Traps
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) Less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): / p
05103101
❑ Yes K No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes M No
❑ Yes ® No
❑ Yes R No
Structure 6
Continued

Facility Number: 31 —133 Date of Inspection l OZ
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [2 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes g] 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 P3 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Cl Yes [SNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 19 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes V5No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes El No
12. Crop type l Z-4 #4 &I -A e
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? El 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 tgNo
t 6. Is there a lack of adequate waste application equipment? ❑ Yes M No
Reauired Records & Documents
17.
Nail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P 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
No
t9.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
W No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CO 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 P No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes V1 No
24. Does facility require a follow-up visit by same agency? ❑ Yes E4 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
a No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
5 - E-:C.-tu wx..,>ir.- - •`fir' .r..s%
Com�ents'(refer tii auestiiin�#1. Exnlaur4anv YES.answers and/or anv=recnmmendatioiis`or'anvsathercomments. s
Use drawmgs of facility totbetter expia►n stthations.`(use additional pages as necessary) ❑ Field Copy, ❑ Final Notes
..
Reviewer/Inspector Name 1
Reviewer/Inspector Signature:
05103101
Date:
Continued

Facility Number: bate of Inspection
Door Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ® No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes fZ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ErNo
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 ;K 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 UNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a pmnanent/temporary cover? ❑ Yes C4 No
Additional:Couments. andlor Draymgs:
05103101

Type of Visit )q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit X Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
E:
Facility Number Date of Visit: �Q Time:
0 Not O erational Q Below Threshold
Permitted [3 Certified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold•
Farm Name: ...CMG.�a.!:�..�77 .................................................... County: ..............................
OwnerName: ............... ................................... ................................................... . ................... Phone No:.......................................................................... ....� .
FacilityContact: ............................................................................... Title:................................................................ Phone No:
Mailing Address: ........................................... x _ m
Onsite Representative: Qk'u "'e"` P`� �° Integrator. �'e .t�w ...."A. c ^^
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 « Longitude 0 1
- . Desiign Current ; .. Design Curreaf Destgn `- Curr=
Swme Ca aci Po elation Poultry ,< Ca aci Po ulatian Cattte Capacity Po ulatFoa
F _ ❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish a. ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
[IFarrow to Feeder ❑Other
❑ Farrow to Finish 'TOW Design CapaCl0-FZ _
❑ Gilts
=` ❑ Boars Total SSLW
Namberb[ i.agotins ❑ Subsurface Drains Present ❑ Lagoon Area . ❑Spray Field Area
p❑ No Liquid Waste Management System Ponds I Solid Tra ` s .: -'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
.0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
"o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
PNo
Structure 1 Structure 2 Structure 3- Structure 4 Structure 5
Structure 6
Identifier: .....................................................................................................................
Freeboard (inches): 3-1
5/00
Continued
on back

Facility Number: f3i — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, (] Yes 9No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 9No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes V No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Rf No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Z No
Waste Aaalication
10. Are there any buffers that need maintenance/improvement? ❑ Yes )q No
11. Is there evidenceofover application? II ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload ❑ Yes kNo
12. Crop type h r SC3 / t W l SL/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Q•violatit?t s:oe def ciejmde' *v i e p0(e4 Oum. g iiis.visit?. Y:ou %1-t; eeeiye 06 fuftboe
Cori espoiidence: a�auti this visit: .. ..... .
fer to question #). Explain.any-YESanswers,and/or any recou�mendations ar
�,.
of facility to -'better exp, - #sitaations {use�addttioonal.pages asWnecessairy}
❑ Yes )Kf No
❑ Yes No
❑ Yes );�No
❑ Yes JgNo
❑ Yes J�rNo
❑ Yes ONo
❑ Yes XNo
❑ Yes No
MYes ❑ No
❑ Yes iM No
❑ Yes No
❑ Yes KNo
❑ Yes IgNo
❑ Yes JffNo
❑ Yes WrNo
C
� � ��1�� SPA- :,� t►-���--� %r - c� c� MCA
1 -7
Reviewer/Inspector Name fcr
-, L'o
Reviewer/Inspector Signature: Date: 5/Ofl

i Facility Number: 3, — 3 Date of Inspections]
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the Iagoon? ❑ Yes Jk'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporwy cover? ❑ Yes KNo
[Additionall Comments an or_Drawings:
5/00

Division of Water Quality
Q Division of Soil and Water. Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number -3 Date of Visit
lj�Permitted 0 Certified ❑ Conditionally Certified (,] Registered
Farm Name: .......... �` �t^S
Owner Name:
�u 06 Time: U= Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County: ...............1�.�............................
. .......................
Phone No:
FacilityContact............................................................................... Title:................................................................ Phone No:..
:Mailing Address: .....................................................................................................................................................................................................
Onsite Representative: _0 -,Q✓ Integrator: G.... 1 :JG�
f �..............................................................
Certified Operator:... .................................. Operator Certification Number:...............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 Longitude • 6 «
Design Current Design Current Design Current
Swine Ca aci Population Poultry Capacity Population Cattle Capacity Po ulation
❑ Wean to Feeder ❑ Layer I I ❑ Dairy
Feeder to Finish J❑ 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 rod- ❑ Subsurface Drains Present 110 Lag-Wln Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
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) El Yes ❑ No
c. If dischargc is observed. what is the estimated flow in gal/min?
cf. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..................... .............•..---------.........................................................................................-..........................
Freeboard (inches): 0�0
5100
❑ Yes ❑ No
❑ Yes kf No
❑ Yes 4No
❑ Yes KNo
Structure 6
Continued on back

Facility Number:-31 — V331 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 4No
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes boNo
(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 NfNo
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 XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes t�No
11. Is there evidence off over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 91No
12. Crop type LJ 15 G Ul
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination'?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23- Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.. Rio vi.... r... defi.� will i-e. . . Rio further.
corres orideirce: a�aulk this visit . .... ......:::::::.... .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use{ drawings of facility to bette�r explain situations. (use additional pages as necessary):
{n
Cl Yes AfIio
❑ Yes (YNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes kNo
❑ Yes b?rNo
❑ Yes MNo
❑ Yes KNo
❑ Yes gNo
❑ Yes VNo
❑ Yes gNo
❑ Yes O'No
❑ Yes J�No
❑ Yes XNo
V

Pacelity Number: ` — 3 Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes kNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 14 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes(No
u
J
5100

-17 _ . . p
_ Division of Soil and Watei .Conservation = O eratton Revrew
0 Dwision of Soil and Water Conservation - Compliance Inspection _
-ADivision of Water Quality Compliance Inspection
-- [].Other Agency - _Operation Review =
Routine O Complaint Q Follow-up of DWQ ins ection Q Follow-up of DS% C review Q Other
Facility Number r 133 Date o Inspection 2 LI MI
Time of Inspection g : JD 24 hr. (hh:mm)
Permitted P Certified [3 Conditionally Certified© Registered [] Not O erational Date Last Operated:
Farm Name: ............... SNP &PV rc n.......... R<—............................. County: ...... 14Ifh...................................... .......................
OwnerName: ......................Grt.o-16 .1- .............&�........................ Phone No: ...0M... '...........................................
Facility Contact: ............ Title:......---...-.- Phone No:
........................................---...............................- .. .
Mailing Address: ......� Y.3...... 1N`CI-... �:?il.�}....U.1....................................... ....... �{!!f.t G�_l�.?�1.tY�.� ..N- .C...................
Onsite Representative: ........... G.ni:il�41.......Ii.�1�Ai!!l .r............................................. Intel;raft?rr:.......
.J..............
Certified Operator: .................... (.". 0A—.11..........J ►J.. ............................ Operator Certification Number:
Location of Farm:
On----- -41 .......... r &......p......... . ...11.1 f
.....................................................................................................
Latitude ' 4 ,i
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
36-72,
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude • C "
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer 1E1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons U ❑Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes N No
Discharge oricinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-inade?
h. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge is observed. what is the estimated flow in galhnin?
d. Dees discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & "Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: `hZ.
freeboard (inches): .............. - ............. ......................
❑ Yes No
❑ Yes No
r11 ti
❑ Yes [j No
❑ Yes No
❑ Yes [A No
❑ Yes 0 No
Structure 6
1 /6/99 Continued on back

acility_Number: 3 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application'? 4❑ Ponding ❑ Nitrogen
12. Crop type ....... C!Q rh...............k � q. ............. ....................................................
❑ Yes
JP No
❑ Yes
fA No
U Yes
❑ No
❑ Yes
0 No
❑ Yes
® No
❑ Yes
V9 No
❑ Yes
[A No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
...... l.....�. deficiencies .were noted Glaring Hiis.visit.. .... .. e... nor further . '
corresporideiace; about; this visit.: _ ; ': ; ; ; ; _ ; . .: ...
❑ Yes jA No
❑ Yes CD No
❑ Yes No
❑ Yes ® No
❑ Yes [A No
ID Yes ❑ No
❑ Yes ® No
❑ Yes N No
❑ Yes [A No
❑ Yes No
❑ Yes No
❑ Yes No
Comments (refe-r to question. #): Explain any YES answers and/or anyrecommendations or any _other comments:-
Use drawings of:facility:to better. explain situations. (use additional pages as necessary)_,. ,-
`?. 6iatw& or atAer oo-O o�' G [K Z -5WJ be YWe3 Mr. VAAYN�,' 1"0, G- �
cr7si S�no-r�- �,�gra.rn- ��wr— �r. rc_Siol i C� kl . 1
c,cien code-, tYf+ T_ 6?6S r�iet� if s wo lac ir• W�l • %r• 'Ltwvu
Y�az p�hrS t� D�4v�� �a�tr�l3(7R� ► ^ t;4 Vi `tki,, -,yN y,
1 T 06$
V,
Reviewer/Inspector Name
Reviewer/Inspector Signature: 4 Date- 744111 11/6/99

a
13 Dtvision of Soil and Water Conservation [] Other Agency'
Division of Water Quality r
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-ue of DSWC review 0 Other
Date of Inspection $
Facility Number Time of Inspection = 24 hr. (hh:mm)
Registered © Certified © Applied for Permit [3 Permitted [] Not O erationa! Date Last Operated:
Farm Name: "`tea County: ......................................................... ............... ............................................. .......................
2� `°` .....
OwnerName:....Gr ....�� ......... Phone No d -- �`.... _�................................... ........................................... .-.....- ..........---.... 81
Facility Contact: ......................... rt.....................................--.--.--..... Title:...... Phone No
rr�� ....-t-,.+� ✓.........................
MailingAddress:...'...1J .. .. ................... ..................... .....................
Onsite RepresentaEive:..v` ` �1 ..!!-fc ...ice+^`.. .. Integrator:......!... ................................
Certified Operator: ..................................................
Location of Farm:
........ Operator Certification Number: .........................................
w
t. ............. ,,�.. �� � �,,.�•.� ate:.... 1
....................... ..--- .....------..--------.. -
Latitude �' �� �" LongitudeF �• �� ���
' Design > Current. Design Current r Design Current
'Swine° s Capactty F"opi lation PouEtry Capacity 'Population Cattle' Capacity Population_
❑ Wean to Feeder
`°
Feeder to Finish
-jCT.)--
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenancetimprovement? ❑ Yes gNo
2. Is any discharge observed from any part of the operation? ❑ Yes O(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other ,,��,,//
a. If discharge is observed, was the conveyance man-made? ❑ Yes t�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 gNo
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 ONo
5- Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 9No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 0No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 1(No
7/25/97

J
Facility Number: 3 k — -3
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes XNo
Structures (LaeoonsMoldine Ponds, Flush Pits. etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
MNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft): ......... ..
10.
Is seepage observed from any of the structures?
❑ Yes
M No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
O(No
12.
Do any of the structures need maintenance/improvement?
PYes
❑ 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 entering4 waters of the State, notify DWQ)
15.
Crop type ---.... ....... ........... ..........! `.......................................................... ........................................................................................................
........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
(X-No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
PrNo
18.
Does the receiving crop need improvement?
❑ Yes
6d 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
22.
Does record keeping need improvement?
❑ Yes
b�No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
M_No
0- No.vioiiations-vr'deficiencies:were,noted-during this:visit.' Yo'U44H receive-n' ' further :
:•:•corresp¢nde�ceabou�this:visit�.•:•,•:.:.: .:•.�.•.:::-:�: . : .: ;:•.•: .: :-, � :; ,...•.
tk5� k-� Chet— Ftq-w if eu
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 8 (T

® Routine 0 Com faint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection $ s 7
Time of Inspection pi o0 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑Registered ❑Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
0 Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: ....rt�i�o....�Ic�... _....... _...., ....__.. __............... County: » ...�ul �c�......... ......__ ..... _....._ ......
Land Owner Name:.. 17i �Y1C .. ..... .....L�i. ----- - .... Phone No:
Facility Conctact:.. taa.-........ lrt �... ...... .... ... Title: _..Dj,,a.TLLjr ..._....... _..... — Phone
Mailing Address: ��3..�.�`�._. �!L..H1d�i� ._�.�.�.... _............... ..... I-
Onsite Representative: �zf14,�fix!a�.... _..f�! r _.... __...-,...._ Integrator: i_.. .. _....__.. ........
Certified Operator: .... . .... . ....... . . ...... . ..... . ....... _...._._.._...... .._...._... Operator Certification Number: ...... 4........ ........_..,
Location of Farm:
Latitude • 4 " Longitude • 6 {i
Type of Operation and Design Capacity
Dist Z. 3 Current Deli n Current , DesignCurrent gn - g
Swtne _ =
C° aet Po "alatiun Poultry Cap"aci _Po `ttlatton ' Cattle ', C act �Po elation"
❑ Wean to Feeder 3R, ❑ Layer ❑ Dairy
Feeder to Finish jr ❑ Non -Lay er ❑ Non -Dairy I
Farrow to Wean g
171 Farrow to Feeder �TotalDes�gn Capacity
Ll Farrow to Finish S
�v,_ _ ..... ... _ _
❑ other T 5L
�.
Number of )1:agoons7Haldtng Ponds Z f ®Subsurface Drains Present
s.
❑Lagoon Area ® Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes lam' No
❑ Yes WNo
❑ Yes 'j;TNo
❑ Yes q No
❑ Yes 09 No
❑ Yes KNo
❑ Yes 5?rNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
54 Yes ❑ No
Continued on back

Facility Number: ....11....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes WNo
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons andllor Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft). Structure 1 Structure_ 2 Structure 3 Structure 4
3 2.?
14. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes ®'No
❑ Yes 0 No
❑ Yes 10 No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................ _ ....W ..SQ1��$�- - .._ .............. ._.... ...............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
24. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certifitl Facilities Qnly
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes ONo
Q Yes ❑ No
IWYes ❑ No
❑ Yes EfNo
❑ Yes ENO
❑ Yes 1N No
❑ Yes 13 No
❑ Yes KNo
❑ Yes �&No
[X Yes ❑ No
❑ Yes 5,No
❑ Yes No
Ef Yes ❑ No
[$Yes ❑ No
Cammentsw(refer to queshan #) , Explam'any YES answers. and/or any recommendations or any other comments:
Use drawings of facihry to better-expla;n situations =)(use add�t�onail. pages as necessary)
•� A �m sl��1d be, h�i k�- arour,J h�ciro�� 16ca�c.� r�r �,�el� ci+i-�1�-z.
Q
1 I �i z. Cvus ior� o�rtG s ar
t hru� wall o � `4�. tar�occx�z --- W v(J bt- �ML3 W *-� ci� a 13
1^ese.40. $oak-t. o4-tows SJvvla
be. mSe**J- Inbt �ti�e err• lit 1010a, �s1 u�J
be e)o"cicci
'b C kN4,-r tkOS%On.
L3• U� kk Vr4 e skwlj
bL OJd4} `(' C �IJM�, ( s sP'r°r Yt� on (ane�
S f m-x S ,o d be-
i- 1�y r►ser (WM6*— A*,()�*�I� numbar (l?,{c.rj
soy � a,,-�
4VOP loQ
adL +L ck0 fAP.
a
Reviewer/Inspector Name k< r
Reviewer/Inspector Signature: _, Date:
rL_ T
cc., Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

f Soil an r - Division o d Water Conservation Other Agency
.........:........
Division of WaterQuality
...:::::::....
-- -
149 Routine 0 Complaint 0 Follow-ue of DWQ inspection 0 Follow-up of DSW C review 0 Other
Date or Inspection 815197
Facility Number 31 133
Time of Inspection F 10:00 24 hr. (hh:mm)
❑ Registered ECertified ❑ Applied for Permit 0 Permitted 10 Not Operational I Date Last Operated:
Farm Name: Shea>,and�tatt. a[pu. 2 S............................................................................ County: D.UPURX ............................................... W.IR0.........
OwnerName: Gxaham................................: Reirlac Ey..................................................... Phone No: 2.1Q-2906.13.81...........................................................
Facility Contact: G.f Aa m.Ke;xat,)t........................................ Title: m1mcr .................................................. Phone No:...................................................
Mailing Address: 1.7. d..lw..1l)v...................................................................................... 0ttwquapin..NC................................................ 2,8521..............
Onsite Representative:.GraEtauLKwite.dy.................... ... ..... Integrator: 1�A. Tfly..jF.3X ly..�:a.I71W................... ........................... .............. ..................
Certified Operator: (;ra ham.J.„....................... Ket7jmdy ....... Operator Certification Number:. 19.65.8 ..............................
Location of Farm:
Latitude F34 • 51 00 K Longitude F 77 ' 44 ° 37 K
❑ Wean to Feeder
® Feeder to Finish 3672
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation? -
Discharge originated at: • ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7125/97
❑ Yes
® No
❑ Yes
X No
❑ Yes
X No
❑ Yes
0 No
❑ Yes 0 No
❑ Yes X No
❑ Yes ®No
Cg Yes ❑ No
❑ Yes Z No
❑ Yes ® No

Facility Number: 31-133
9. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons,Holdine Poncls�Flu_s_h Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ® No
❑ Yes M No
Structure 5 Structure 6
Identifier:
Freeboard(t)):................3...............................21...........................................................................................................................................................
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?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
Of in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type........Com.(Sijag..&.aaju)....... .................... avybcaa.................................................. .............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
�J No. Viiolatibns' or'derwiericies. weee'noted,duriing this .,visit* -!You r�Urueive'no farther.
......... ... .......... ........................
:cores'vudei�ce al�ouf khis:vasiti .... ....:...................:........ .
(K Yes [] No
0 Yes El No
❑ Yes ® No
❑ Yes ® No
❑ Yes
N No
E] Yes
® No
© Yes
® No
Yes
No
Yes
No
❑ Yes
® No
0 Yes
© No
0 Yes
0 No
® Yes
0 No
❑ Yes
© No
i. a berm berm should be built around hydrants located near field ditches.
./12. Erosion areas on the inner wall of the lagoon should be filled with clay and reseeded. Bare areas should be reseeded. Wet pipe
From I st lagoon should be extended to prevent further erosion.
23. additional aceeage should be added to the CAWMP. Has sprayed on land not in CAWMP.
24. Spray recorrds should be kept by riser number and field number. Updated soil and waste analysis should be added to the CAWMP.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: nl— IA . Date:

Facility Number: 31-133 Date of Inspection SI5197
7/25/97

'
• ! ❑ DSWC Animas Feedlot Operation Review
0 DWQ Animal Feedlot Operation Site Inspection
RECEIVED'
AUG 21 1997
Q Routine O Complaint O Follow-up of DW'Q inspection O Follow-up of DS\VC review O Other
Facilit-,, Number 3
Date of Inspection
Time of Inspection 0 24 hr. (hh:mm)
Total Time (in fraction o1' hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection (includes travel and processin2)
❑ Not Operational Date Last Operated: .....................................................................................................................................................
FarmName: ........................... ................ ... .. ........................................................... County......................................................................................
Land Owner Name:......:........Phone No: .....
Facility Conctact: Title Phone\b:......................:...:............................... :r....................................................................I....
iliailingAddress: :.................................... ................................ .....-...................... ................. .........
Onsite Representative: ...:....:....::..:.::.................::::...:..::..':4................
Certified Operator:
Location of Farm:
Integrator: .......':......
Operator Certification Number: .........................................
....................................................................................................................................................................................................................................................................... 49
............... ................. ....................................................................................................................................................................................... ............ ....................
.............
Latitude 0 4 :i Longitude • 4.
type of uperatton ana imsrgn Capacity
Design Current Design. Current Design Current
Swine Ca aci Population Poultry Ca acity Po Population Cagle Ca vacitv Po ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Non -Layer
El Feeder to Finish ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder T.otalV Design Capacity
Farrow to Finish
El Other Total SSLW
Number:of Lagoons,/,Holding Ponds Z O Subsurface Drains Present
at ❑ Lagoon Area ❑ Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. if discharge is observed, what is the cstimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4I; 4/9 7 maintenance/improvement?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes -"❑ No
❑ Yes [] No
❑ Ycs ❑ No
❑ Yes ❑ No
❑ Yes No
[] Yes ❑ No
Contiimed on hack

FaFility Number:.,.-• .1•..-........1�.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
UNo
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[$ No
Structure. Ilan ons and/or Iloldina Ponds
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Freeboard (fl.): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
3 2_. _7
10.
Is seepage observed from any of the structures?
❑ Yes
EgNo
11,
Is erosion, or any other threats to the integrity of any of the structures observed?
(R 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
9No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
Q No
(If in excess of WMP, or runoff entering waters of the State,notify DWQ)
15.
,1
Crop type ................. jc.C14..,a..... ........................... I................. S «:.... ............................... ..................._..........................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
0 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
❑ Yes
QNo
19.
Is there a lack of available waste application equipment?
❑ Yes
[&No
20.
Does facility require a follow-up visit by same agency?
[aYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[RNo
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[gNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
[Yes
❑ No
24.
Does record keeping need improvement?
[3 Yes
❑ No
Comments (refer to question #{):-;Explaini any. YES answers and/or: any, recommendations or any other comments.
Use --drawings of facility to better explain situations._ (itse:addition it pages as necessary): kk
�. f=+ �h" . �. �liu�.+ J ._ 1�}r � a- rr�L; •V �-� i'? TS '-G:/,+t.O rU f-. F [_-: � 1 � l ..i � �� < Q
1 4
'w
L,t:'.
�. o�t1 '^� 4 ° �.; l� .��- i,i)[iP�} ++., ��i�: L .'���.V,�'�li �'. :i'�rGi�'.� G, !C'tC� j.u' ,1 �.,`'.J?•it'
1�. S,4?:: +� i l(_U,d; Sl;uv it �t i=3.i1�' Yl,•� r' i('t i1iJ1q)k+.
tul'�Ic +,'c• Iti' �� S ,t u,., d oc., CA } ,.Aj1
Reviewer/Inspector Name --t #ar , • _� m
f r _
Reviewer/Inspector Signature:,
- �)1
Date:
_
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

- u�fi` ftt Ow , rat;, ;azt ' +, t. '� " �s { aq=F e:zr4 r t' i
N.CDA,A ononttc;Dtvlslon 300;.Rec,d ,Crecic Road: italel h�NC 27 07,g 6��(919 733>2�5.5. J � Re o1- tlYo. li911� :
Grower.- Kennedy, Graham
Copies to: Agriment Services Inc.
1783 NC 11wy I I 1 S
x4
Soil
Test
Chinquapin, NC 28521
Rjohort
Farm:
110 Bo 1 ServiCCS InC.
f 0 Box 1096
Beulaville, NC 28518
12/ 4/96 SERVING N.C. CITIZENS FOR OVER 50 YEARS
Du Fin Count
Agronomist Comments:
M :k'.i
Fieldhlnfort�atlort. �� � � �.
lied'�Lime
R ',L;-' i i .:,.
RRecomn�endationsa =�,r�'F ,� �..�.'�� �rt.r,K �E� �'es��N
Sample No. Last Crop
No, Yr T/A
Crop or Year Lime
N lr05 ICAO
Afg Cu
Zn
B All, See Note
GK1 Corn, Grain
1st Crop: Small Grains AT
80-100 0 70-90
$ 0
0
10 3
2nd Crop-, Soybeans 0
0 0 70-90
$ 0
0
$ 3
Test Results
Soil Class HAM W/V CEC BS%
Ac pH P-1 h-1 Ca% Afg%
Mn-1 AM-A1 (1)Mn-Al (2) Zn-1
Zn-AI
Cu-1
S-1 " SS-1 NO3-N Nlh-N Na
MIN 1.68 1,25 5.3 680
1,7 5.8 81 29 56.0 9.0
22 23 23 107
107
62
39 0.1
i w'�o•d ni(Itlons -'.R1fY x'ii: `,dim
.yx:.
p
eco 'Xw q � :j LS' ~i
CvY �it��b! #. F �x �. - �^� i`. i6[_. �', ., S f.
a
_ YY � �y...b: ak�r-X ',M11�x. ._
M
Sample No. Last Crop
o Yr T/A
Crop or Year Lime
N- R05
Afg Cu
Zn
B Mn See Note ;
GK3 Corn, Grain
1st Crop: Small Grains Ip
80-100 0 110-130
$ 0
0
0 3
2nd Crop: Soybeans 0
0 0 110-130
$ 0
0
0 3
Test Results
i
Soil Class 11M% W/V CEC BPA
Ac pll P-1 K-1 Ca% Mg%
Afn-1 Mn-AI (1)Mn-A! (2) Zn-1
Zn-Al
Cu-1
S-1 SS-1 03-N NIL-N Na
MIN 1.08 1.41 3.4 47.0
1.8 5.2 81 13 39.0 5.0
34 30 30 . 107
107
54
24 0.1
k :•�: -4w..2L ii, �
Il� nliltIOfl,. 'lea,,
FieId:T or ..<� �..�;
�
4" „lied..L`iirie
.d-11.. .. - A er.`ti Y'•' Wes(. 53 v' - r. 4.p,e�' fgrxn-S y^_
`Reco"n�mcnda a5
dons_ ,. ,ko
SS,
.. .i t �•.GR yy :"S
Sample Alo. Last Crop
Alo Yr T/A
Crop or Year Lime
N M5
Afg Cu
Ln
B Alit See Note
GK2
1s( Crop: Small Grains .7T
80.100 0 0
0 0
0
0 3
2nd Crop: Corn, Grain 0
120-160 0 0
0 0
0
0 3
Tcst Results
Soil Class I1Af% w/V CEC BS%
Ac pll P-1 h-1 Ca% Afg%
AM-1 Afn-AI 0)AM-Al(2) Zn-I
Zn-Al
Cu-1
S-1 SS-1 N05-N N1h-N Na
MIN 0.6 1.32 3.1 58.0
1.3 5.3 276 151 24.0 10.0
98 69 76. 39
39
50
35 0.2
rk.k,
Meld lnform.ltlori Yam.
a
A> >11ed Lln a
i F.:. k3Y9
Rcco°misicnclatioti's u r a
��
w " ,w
�� �.,;�� ��
Sample No. Last Crop
Alo Yr T /A
Crop or Year Lime
N hO5 KO
Mg Cu
T,n
B Afrr See Note
C.K4 Corn, Grain
1st Crop; Small Grains AT
80.100 20-40 40-60
$ 0
0
10 3
2nd Crop: Soybeans 0
0 20-40 40-00
$ 0
0
$ 3
'rest Results
Soil Class HAM W/V CL•'C IIS%
11C pit P-I h'-1 Ca% Afg%
AM-1 4111-til (1)A111-AI (2) T,n-1
!,n-AI
C11-1
S-1 SS-1 AQ-N NJh-N Aa
MIN 1 0ti 1.39 3.2 50.0
1A 5.8 49 4(, 420 6.0
24 24 24 69
69
i.S
28 0.1

�. .. . • I^^ R�liitFFlYrt,.r '• '�,'•,'�i�i."1^' t 1%A: r}Sc?,s"5'r' a.:3�1,v-`:
I CDA�A ,ono017Divis onA, 4300;Reed .;Cree Roa , #rRalei i7�NC 27 07 "4 5: Q19 k733s2655' Grower enned ,�Graliaril,
As4e T•'1d x
� ``'Rc o `: `No:1129.1
Fieiil,Infor`matiiici
Iicd Liiiie
; 8&ffmcndatioi s
Sample No. Last Crop
GK5 Corn, Grain
Ho
Yr 7'lA
Crop or Year Lime N M5
Isl Crop: Small Grains 0 80-100 30-50 60-80
2nd Crop: Sobeans 0 0 30-50 60-80
Mg Cu Zn
0 0 0
0 0 0
R Ain
0
0
See Note
3
3 .
Test Results
Soil Class 11A1% W/V CEC
MIN 1.43 1.37 4.4
l3S% Ac pll P-1 K-1 Ca% Mg% Aln-1 hln-Al (I)Mn-Al (2) Zu-1
75.0 1.1 6.0 43 34 58.0 13.0 34 30 30 122
Zn-Al Cu-1
122 88
S 1 SS-1
41
NQ-N Nih-N Na
0.1

A "Re2art NCDAAgronoiiiic Division .41300 Recdy,Cr6ek,-Roa'd�',�Ftl�igii,
Grower.- Kennedy, Graham Copies 7b: Agriniew Services [tic.
1783 NCII%%y ill S USDA-NRCS-l)uj)liii
Chinquapin, NC 28521
Agriment Servicc-, Inc,
Waste Analysis
W Al,
effort hur7n: PO Box 1096
Beulaville, NC 28518
7/31/1) 7
Duplin County
SaFhp[6 lnk-6
b dul6i",(O i�v, fu Ia oratory R , eF'iiiillibdtinl-sSoathe
Sample ID:
N i
P K Ca Mg S Fe Mn zn Cu B MO Cl C
cKl
Total 756 M
52.6 735 101 34,2 22.6 6.48 0.25 0.57 0,72 0.97
IN -N
M If M M M M M At Al M
Waste Code:
-NI14
Ala Ni Cd Pb At Se M P/I SS CIN DM% CCE% ALLao
AIS
-NO3
193 7.14
Description:
OR-N
Swine Lagoon Lig.
Urea
H
6 d' t i ou Crdp5,R
b 00
,
R,
IrrWo a
W. la-6oratde�iResulo
mi owun eM
Pa ,Per ess ot 'R
Sample ID.,
/V
P K Ca Mg S Fe Afn zn Cu B Afo Cl C
Total 686 M
48.2 712 87.7 30.0 21.9 6.09 0,23 0-52 0.64 0.89
IN -N
At if M At At Af Al Af At At
Waste Code:
-NI14
ALS
-AI03
Na Ni Cd Pb Al Se U P/I SS C-N DM% CCE%
185 7,76
Description:
OR-N
Swine Lagoon Lig.
Urea
n
T'-
Nutrients ijjjAle f6r'First Crop
01her Wd6&
lj&jjnuiie'6da"tio' s:kV
•zfbill
App#c�afion Atelhod—'A--- 20K 20� At Fe Mn 7tC--��,5. 75,-t�7 M( --.2— -�Cl
4 N Ni Cd e
a -�'Pk- V AI S
irriga ion
-5 7- '0, 13 0 .04 T T "T
4

r
NIZ eA
I-P
7, h4l op
JV4
33

0
•
Site Requires Immediate Atte o : J_J5
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIO S §ITE VISITATION RECORD
DATE: , 1995
Time- lvza
Farm Name/Owner
Mailing Address
County:
Integrator.
On Site Represents
Physical. Address/I
Type of Operation;
Design Capacity: 107� _. Number of Animals on Site:
Phone: l gX x8j _ d_1 /q
36 k- r—1hold l
DEM Certification Number: ACE. DEM Certification Number: ACNEW
Latitude: 36-3" Longitude: _77 ° '" Elevation: Feet
/2177 311p Q Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm
storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: �Ft. & Inches
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? es No
Crop(s) being utilized: & �S
Yes or No Was any erosion observed? Yes or No
Is the cover crop
vzi P15 �
:e?,Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es r No
100 Feet from Wells? Ye 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 or NoT
Additional Comments: 11/) Ld7} S We)
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.