310143_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

+i _
C>
type tic ompnance inspection u vperatnon Keview u ntructnre r:vaivanon u t ecnnical Assistance I
Reason for Visit: 04outine Q Complaint 0 Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: t, (�� Arrival Time: Departure Time: ► L(� County: b., �j Region: �t}
Farm Name: 7�,L �,er�,�� �I � lv,� ���:.-+ Owner Email:
rr ED/NCDEMR/DWR
Owner Name: +J 3 i�vul Phone:
Mailing Address: AUG 17 2017
Physical Address: Water Quality ReP)nnal
Facility Contact: r4w4t 5 t.) 6L 4A (c _ Title:
Onsite Representative: r
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Yvi,mington Regional Office
Phone:
Integrator: K t3 p� /
Certification Number: [ �O Z
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Desi n
Cattle Capacity
airy Cow
C•urreat
Pop.
Wean to Feeder
L
]Non -Layer
airy Calf
Feeder to Finish 't 3 B0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
=M M
Design Current
P:ouIt, Ca acl P,o
Layers
airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Non -Layers
HPullets
Beef Feeder
Boars
Beef Brood Cow
Turke s
lather Turkeyl'oults
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 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 �o ❑ NA ❑ NE
❑ Yes [:]No B--NA ❑ NE
❑ Yes [:]No EJ-1 A ❑ NE
❑ Yes ❑ No
❑ Yes [TT�o
❑ Yes ff No
E3 —A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

lFacility Number: - 4 Date of Inspection:
G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D-N.9-
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q-NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q-i�rb_
❑ 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
Q'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�o
❑ NA
[] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
I ] 110
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes To ❑ 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):(J
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E3-N-o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes LJ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes a�lo ❑ NA ❑ NE
❑ Yes Fj o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑~1q_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
El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[]Ko
❑ 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
❑flo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�r`No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

10
lFacility Number: 3 - 4 Date of Inspection: L
24.1Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [gNa— ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? Ifyes, check ❑ Yes �o [:]NA [:]NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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
ED-N6
❑ NA
❑ NE
❑ Yes
Q-Ko-
❑ NA
❑ NE
❑ Yes
D'No
❑ NA
❑ NE
❑ Yes [ ❑ NA [] NE
❑ Yes ❑_lo ❑ NA ❑ NE
❑ Yes U Ko ❑ NA ❑ NE
[:]Yes L le
[:]Yes 2-140
❑ Yes Er�o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Reviewer/inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: aCo nee Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: I °� pp Departure Time: 0 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
r
Onsite Representative: �l C �do e (Nbe-ri S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1 Op o 30 7
Certification Number:
Longitude:
Design Current
Swine C+apacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
I
jNon-Layer
I Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current Dry Cow
ll , I;oultl, Ca aci_ to , Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
I
Boars
Pullets
keys
Turkey 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �o
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

Facility Number: 43 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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:_ SZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 � - 3 t --
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o Q NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo❑ 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 Cal o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NrNo
❑ 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
E] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YfNo�[:]
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 ffNo ❑ 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? ❑ Yes PNo ❑ 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

)racili Number: jDate of Inspection: Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑-t`o 0 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.
❑ F
a tocomplete annual sludge survey ❑ Failure to develop a POA for sludge levels
ompliant 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 ❑ 1' o ^❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No KA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ej 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
�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
[5 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
0—No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑'ffo
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�❑
[�'hfo ❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
Z/ 7-
214120I5

Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
�,. Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other
�0 Denied Access
Date of Visit: ,Zj C Arrival Time: od eparture Time: C1 unty: �/t f,�( /� Region: �i
Farm Name: S�1a Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: BELA k)o l L l s
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: -/" `'
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Design Current
Swine
Capacity Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
DEN P,oultr, Ca act I;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes -ETRo
❑ 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 E f - o
❑ 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 -E!rRo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes -Eno
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes ,E]INo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes,,ETNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes J23'1�o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 [5-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes _L2-No
❑ NA
❑ NE
8. Do any of the structures 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
❑ Yes 13-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ,E�'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ID -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 _JL3`No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes EJ-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes _fD-No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes , TNo
❑ NA
❑ NE
Required Records & Documents
,
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes__fE�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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes _4E3-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;2rNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 1.1 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6No ❑ 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 J[3'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ErRio ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C;T'No ❑ NA 0 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 Q-No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ;No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes La'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 U7 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑" No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 12-N-u-
❑ 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 fuse additional pages as necessary).
Reviewer/Inspector Name: yt Phone:q/O C ! �13C
Reviewer/inspector Signature: C Date: 3 /
Page 3 of 3 2 /20II

I�
Factlity:-Nunibeir
ion r Quality
ither'Agency
Type of Visit �4E�F_Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vis!V(! Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Ig CrU I Departure Time: County:
1
Farm Name: 7 -. h� SSA ✓a S h 5 JC, L 4�1: irn^ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: A 4 a I Title:
Onsite Representative: rfwltj l-(S
Certified Operator:
Back-up Operator:
Location of Farm:
PI one No:
Integrator:
Operator Certifiation Number:
Back-up Certification Number:
Region:
Latitude: [= o = I = a Longitude: [= o = 4 = 1f
Design Current Design Current's
Swine Capacity' Population `Wet Poultry it PopulOoo
❑ Wean to Finish ❑ La er
:.� ❑ Wean to Feeder ❑ Non -La er
Eli]
❑ Feeder to Finish'
w
s _ -
❑ Farrow to Wean Dry Poultryr �� 4
❑ Farrow to Feeder
❑ Narrow to Finish
1'IIJ Boars
❑ Other
❑ La ers
ion r Quality
ither'Agency
Type of Visit �4E�F_Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vis!V(! Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Ig CrU I Departure Time: County:
1
Farm Name: 7 -. h� SSA ✓a S h 5 JC, L 4�1: irn^ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: A 4 a I Title:
Onsite Representative: rfwltj l-(S
Certified Operator:
Back-up Operator:
Location of Farm:
PI one No:
Integrator:
Operator Certifiation Number:
Back-up Certification Number:
Region:
Latitude: [= o = I = a Longitude: [= o = 4 = 1f
Design Current Design Current's
Swine Capacity' Population `Wet Poultry it PopulOoo
❑ Wean to Finish ❑ La er
:.� ❑ Wean to Feeder ❑ Non -La er
Eli]
❑ Feeder to Finish'
w
s _ -
❑ Farrow to Wean Dry Poultryr �� 4
❑ Farrow to Feeder
❑ Narrow to Finish
1'IIJ Boars
❑ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef feeder
❑ Beef Brood CoyA
Nip
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
dNo
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: - Ds ection:
Waste Collection & Treatment
4. I, storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo
a. If yes, is waste level into the structural freeboard? [—]Yes 7No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes WNo ❑ NA ❑ NE
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 environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes CdNo ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 4No ❑ NA ❑ NE
❑ Yes VT No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes No [a NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 14 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes `f'' No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: (- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes .0 No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ZNo ❑ 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 [,2 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ONo ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
14 No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
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)..
Reviewer/Inspector Name: % Phone: U _1,
Reviewer/Inspector Signature: Date: Z
Page 3 of 3 /4/2011

IType of Visit grcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ��—` Departure Time: County:
Farm Name: �� kal l� V \ 0 LAlf Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
n°
Phone:
Region :%✓/�
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Longitude: --] ° F—T 0
Design _Current 'Destgn, Current k aDesign Cu rr ept -
.< .,
Swine: Capacity, Population Wet Poultry Capacity Popularion Cattle _CapacityPopulat,o
❑ Wean to Finish_ ❑ Layer
ElWean to Feeder ❑ Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean"
Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish " El Layers
❑ Gilts ❑ Non -Layers
❑ Boars ❑Pullets
❑ Turke s
then, ❑ Turkev Poults
] Other
�u Other j
ta:
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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
—JE]
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
�Numbe
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 JPNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�no
❑ Yes
/No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
Page. I of 3 12128104 Continued

Facility Number: — Date of Inspection aU
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 VNo ❑ NA ❑ NE
Struc re 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 ON. ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0No ❑ 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 �J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
XNo
[:3 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ICI No
❑ NA
❑ NE
Commentsb(refer to questions#) Explarn;any YESanswersandlor�anysrecoinmendahonsorany other comments
,... :..: �.. e _ .°'�,.„b .�
Use drawings of facility to better explain situations.;{use:'additional pages,as',necessary}�,
_ r
a:�...
..
Reviewer/inspector Name y Phone. C/—
Reviewer/Inspector Signature: _ Date:
Page 2 of 3
Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 21�o ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes Pqo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers El 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 ;3/No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0- o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes _;).No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes fL214o ❑ NA ElNE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes jallo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ZTNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,2 &o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes �'�Io ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ;;'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 2fNo ❑ NA ❑ NE
General Permit?. (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �o ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ;2No ❑ NA ❑ NE
Additional Comments and/or Drawings:
r�
2 3 �i'P� ►�K-t��i eU� i
91avl 6n eeef/� Ag/a .r4
a< l��' 6C6
Page 3 of 3 12,128104

V
0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservati /
- — ,dpw QWdtber Agency
Type of Visit Z'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 _ Arrival Time: .' ���^G� Departure Time: County:
Farm Name: a Y V h <'.] r, c� Y 1 0 4 r Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: I P i _` S` �C (T ✓\
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Latitude: ne
Phone:
y� Ph ne No:
Integrator: 1 i�
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et - --
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Region:
Longitude: = ° =' = "
Design Current
Cattle Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife}
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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
El Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

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

i/-?
'Facility Number: 2W Date of Inspection
Reguired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes e, No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 4!JNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes iTNo
❑ NA
❑ NE
❑ Yes o
Z)2rNo
❑ NA
ElNE
ElYes
❑ NA
❑ NE
❑ Yes PNo
❑ NA
❑ NE
❑ Yes .0-No
❑ NA
❑ NE
❑ Yes g No
❑ NA
❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes �ZNo ❑ NA ❑ NE
❑ Yes rNNo ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes �Vo ❑ NA ❑ NE
❑ Yes /� No ❑ NA ❑ NE
12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other / [I Denied Access
Dare of Visit: Arrival Time: Departure Time: County: cc // Region:
Farm Name: -"`�� h. _ 6 D ba 1------ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: �IPhone No:
Onsite Representative: l Integrator: ' vc
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 i 0 Longitude: = ° = ` 0 "
Design Current surrent
C•apaeity Population Wet PoultryF(�ap!a�cpulation
Design C►urrent
Cattle Capacity Population
inish
7TVean
❑ Layer
❑ DairyCow
We eeder
❑Non -La er
❑ DairyCalf
❑'Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ DairyHeifer
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
EGilts Non -La ers
Boars
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
❑ullets Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
Discharlfes & 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
Cl NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection G `
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (f'�+r • - - — - --
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA El NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or"any other commentsf
Usdrawn s:of facility to better explain situations..(use additional pages as necessary): �. r
Reviewer/Inspector Name O �- Z_T phone;
Reviewer/Inspector Signature: _ ,/L '_ Date: 3 d 6
Page 2 of 3 12128104 Continued

Facility Number: 13/ Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
� b 1 � � !� y"auncPc w0.-
-- C on - r am ofA r 4ja s 5
CA foU/It� la ode
Qt
ec(3(ro
H.,
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assis=Access
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Deni
Date of visit: Y6 Q Arrival Time: ��j� Departure Time: aunty: L_ Region:
Farm Name: O(fiSl n� SflBG/fl��RM/ #� Owner Email:
Owner Name: , �l.P�ii�lf FzL /%1 s ^T Phone:
Mailing Address:
Physical Address:
Facility Contact: % Title: Phone No:
Onsite Representative: lm_Ce /a Integrator:. /' 14�iQ�'`1' � [ 1�✓
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 = Longitude: ❑ o ❑ d ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer ::::::]
1
_� ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Caw
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)?
Number of Structures: ©�
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ;A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
1z No
❑ NA
❑ NE
12128104 Continued

Facility Number: 7Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes JZ 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: 0/ 07--
Spillway?: O QA
Designed Freeboard (in): Q, S / ES
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ,I 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 VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 21 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 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Wf 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 Acce table Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) O 86-4,)-5 1�,544q
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:]
Yes
VNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
)� No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
UfNo
❑ NA
❑ NE
IReviewer/Inspector Name`j Phone:
Reviewer/Inspector Signature: ��_ Date: i7
12/28/0,f Continued

r
Facility Number: 5 —� Date of Inspection 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 'VNo ❑ 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 /0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
El Yes No El NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA NE
❑ Yes
ZfNo
❑ NA
❑ NE
❑ Yes
W(No
❑ NA
❑ NE
El Yes
4No
El NA
❑NE
❑ Yes 7rNo ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
❑ Yes 7(No ❑ NA ❑ NE
Additional,Comments,anid/©r Drawings
12128104

Type of Visit ,C5 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: S G 0 Tune:
0 Not Operational 0)Below Threshold
ermittedYCertified (] Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
FarmName: ....... ...514oiR2_.....---•-----•.......................•---........_................................. County: ............. Abp............ _.......... .......... ...... .........
OwnerName: . .... ..................................... .... . Phone No: .._..........................
Mailing Address: ...........
FacilityContact: ... .--••-.----------•-..................................................... Title:...... ................_..... ....._. Phone No:
Onsite Representative:..jYiSL �,-ice?.................................................. Integrator:.....................................................................................
Certified Operator ............................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° " Longitude • 4 69
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes <No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes L"l No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. I. ................... .......... ZQ......... .... ........................ .......... ....... ._.................. ........ ..... I ................. .... ...... ... ...........
Freeboard (inches): 3 5 `
12112103 Continued

Facility Number:1
Date of Inspection (o d
5.• Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type CJ
❑ Yes UICO,
❑ Yes RdNo
❑ Yes 0 /No,
❑ Yes ;N70
'
❑ Yes
❑ Yes VX0
1
El Yes
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes .l70'
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes N
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes ZNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes to -
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.
Commeats (refer to guestroa#)F.xplam YFS-answers and/or arry,reraommendatzoas or aay othemtiients�p
Use drawEnpS fac�ity to better exglatn srtnaboas (nse addt�onal pages as necessary)• d Copy ❑ Final Notes
Z m
W.
= _
"' • _ _5 �. Jam. __r-ye"'Y�..-h�v'r, s"" ...- .� .. -. L..-^^.S
FAR -AA lrtJ GMD S�4fflC- ,
c 2CcaADS <--t � FA 2NM oo �S3T�
is C
Reviewerampector Name `° - .L - `t
w ? �
Reviewer/Inspector Signature: Date: 916, p
I2112103 Continued

Facility Number: —
Date of Inspection
Reciuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required fortes need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes ff 10
❑ Yes 2'No
❑ Yes No
❑ Yes ono
❑ Yes WO.
❑ Yes I o
�es[3pNo
❑ Yes
❑ Yes
❑ Yes Ld No
❑ Yes �N`ov
[]Yes o
12112103

'r
Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number slate of visit: D Time: �f>
Not O erational $eloK• Threshold
Permitted ©+1C
-ertified E3 Conditianally Certified{ 0 Registeered Date Last Operate Above Threshold:
Farm Name: .,0140 54t•1 5HIDIIRP. r RM I* Ea *2_ Count}: �iJ[.�PL-7-N"
Owner Name: hone No:
Mailing Address:
Facility Contact: Title: M Phone No:
Onsite Representative: Integrator:
OP*Ey C tw e - .4
Certified Operator: Operator Certification Number:
Location of Farm:
4 Swine ❑ Poultry
Swine
=m ❑ Wean to Feeder
Feeder to Finish
_ ' ❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
�
�u curs
.-� ❑Boars
❑ Cattle
Design. _
❑ Horse Latitude 0' 0• �K Longitude a 0•
❑Layer I
I
Dairy
❑ Non -Laver
1`
❑ Non-Dai
I Number of Lagoonsi ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area I
Holding Ponds J SohdTraps m ! ❑ No Liquid Waste Management System' y
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves. 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: 44" d
Freeboard (inches): 2
05103101
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes [--]No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes EZNo
❑ Yes ❑ No
Structure 6
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,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (H any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
❑ No
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
I0. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
I2. Crop type
11 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
I5. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
Ff.
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VfNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Corr n6ts (referto-question #) Eirplatn ally YES;answers�and/vr=aar reccmrngodations',tir anYother comments
_ _ _ _
Use drawings of faciltty,to"better.e`irplaut srtuations:;(use aciilrnonal pages as necessary) `❑Field Catsv ❑Final Notes '
<- - k e
`��s�t=�r1-oN o�pucT�P F-e�us� DF orr,e><�zrJ-� RLL
R�o�-� W �5-�� �Q�z seRAy o tj
CO rJ Tat') Lk �� � �� !"�tA
Reviewer/Inspector Name r T �
Reviewer/Inspector Signature: Date: 2 1}
05103101 Continued

a < x
Facility Number: ',�j —/ Date of Inspcctinn
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below El Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e- residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ do
31. Do the animals feed storage bins fail to have appropriate cover? ElYes ElNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
[Additional; Comments and/or Drawings:
�TcNrS
--- 0p 1F—\)ZD4�t3C-t d1 �1 C—' 1\09 �psTE �;J oAP
`moo f [4- L Ate Q � PLzC 4�-rc o N i Tr , 4 R �
Fp DuYs2r AZE LA-0.o
9 T� P� -CA Two rJ
f_ C(R4F—' � _ 0 5 �7T�LC i\0 F
o
AA i� �sT� z
� R
24Lc lye Tri 5U
W1Q&
O5103101

Type of Visit /T 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 Date of Visit:
Permitted [3Certified © Condition
Conditioily1 Certified # [3 Registered
Farm Name: ' 500 _�— DLAk _ I _IX l�
Owner Name:
Mailing Address:
Facility Contact:
Title:
OnsiteRepresentative: fW.Lf- 0ORRr5
Certified Operator:
Location of Farm:
Date Last Operated2)e1PZ101'j
Above Threshold: _
County:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
ASwine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 Du Longitude a 6
ILI Wean to Feeder 1 .1 Is
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
No Liquid Waste M
Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes to 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 ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 0
Freeboard (inches):
05103101 Continued

Facility Number: 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O'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 YesINO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? El �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level %
elevation markings? ❑ Yes jT�j No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes o
11. Is there evidence of over application? Excessive Ponding ElPAN ElHydraulic Overload ❑ Yes VNo
12. Crop type aws
13. Do the receiving crops differ with t1lose designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,rfNo
14. a) Does the facility lack adequate acreage for land application? El[J Yes LNo
b) Does the facility need a wettable acre determination? ❑ Yes / o
c) This facility is pended for a wettable acre determination? ❑ Yes o
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes X
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit? f
(ie/ discharge, freeboard problems, over application) ❑ Yes I[J No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes X_�
No
24. Does facility require a follow-up visit by same agency? El Yes o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer to , uestjii E' lain any YES answers and/or -any recommendagons or any pt er comments
[1se drawings of facility 6o beater eg�Plain s tuatious."(use addtioual'pages as necessary) Field Copy ❑ Final Notes
5uLA T z0^1 % A3E ,Emed,450 •eow),
oohs L`�AvE u -r PFPc-NCED � {Otr�.�C-o� �.� S ��rJ �
�pr�
7� ° F��RU�tr�'n1� 5.� .J �R�0�2 . /:'FC'�.eDs '40ee cy 41,10
H,
Reviewer/Inspector Name .:;.;�
Reviewer/Inspector Signature: Date: / O
05103101 Continued

s
Facility Number: -1,3 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the Iagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments ,and/or Drawings: ;., '_
❑ Yes ❑ No
❑ Yes No
❑ Yes [No
❑ Yes PNo
❑ Yes XN
El Yes o
❑ Yes ❑ No
05103101

Facility Number Date of Visit: 8 j �% L51 Time: 3D
Q Not Operational Q Below Threshold
13 Permitted [3 Certified U Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ° i.. 1; ......................
'l County:
Owner Name: .......V `....�"�.~'`..`. r'".5........................ Phone No: ........................ .._........................................�.� » ...._�
FacilityContact: .............................................................................. Title:...............................---.............................. Phone No:...................................................
Mailing Address:
/� l
Onsite Representative:.I..' Ls:G ►�� „!.v �,� r! Q f Ol J LeW ,` Integrator: , r ....
....}................................................ ..........
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ���
DesrgQ ; Current Design Current Deign
Canacity Ponnlation Poultry
CjjkjdtV. Po elation -. Cattle - - Canaritii Pii
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other -
Total `Design: Qipscrty
'TotaISSLW
Discharges & Stream .Im acts
1. Is any discharge observed from any part of the operation? ❑ Yese �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .................. ................................�-.........................
......................... .................................................................
Freeboard (inches): 2-17 3
5/00
❑ Yes &3No
❑ Yes ,ffNo
M J41
❑ Yes J'No
❑ Yes XNo
❑ Yes UNo
❑ Yes '140
Structure b
Continued on hack

Facility Number: — T Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes,ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes J214o
(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 ` 3 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
El Yes )2rN0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes gNo
Application
_Waste
10. Are there any buffers that need maintenance/improvement?
❑ Yes XNo
11. Is there evidence1 ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
❑ Yes PNO
�of�over�application?
12. Crop typey Y h-e `1rIji-ti
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes No .
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ONo
b) Does the facility need a wettable acre determination?
❑ Yes,&No
c) This facility is pended for a wettable acre determination?
❑ Yes No
15. Does the receiving crop need improvement?
❑ Yes �No
16. Is there a lack of adequate waste application equipment?
❑ Yes RNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes No
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes 0 No
/
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ YesXNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes KNo
24. Does facility require a follow-up visit by same agency?
❑ Yes ZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes '10No
o-yioi�t iVt>}s;o dg. I ,f-ie's -were pQte� d1H°ing �h#s'v.. •Yost wii� �eeeiy....... .
Mire's deike. a bbif this V1R
Comments (refer boquestioa #) Explatri any YFS answers and/or any recommendattons or:an other comtraents.
.
Use _ wings ntber expinittati-addi-oeas necesmu7f gags
Reviewer/Inspector Name -� E
Reviewer/Inspector Signature: � � �/ r Date: 5/00

Facility Number: 3 —f 3 Date of Inspection f 9
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 i7No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes'ONo
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 11 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.) ❑ Yeses TNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes _,RNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5/00

Division of Water Quality
-
4
O Ditis_ion of Sot1 and Water Conservation •`
77
Other-Ageiacy
---
s
(Type of Visit ACompfiance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit oRoutine O Complaint O 1=ollow up O Emergency Notification O Other ❑ Denied Access
Facility Number
i)ate of Visit:
31 3
Permitted 0 Certified© Conditionally Certified U Registered
Farm Name: .......J�'f r1 SDf?—S�....G�. rr,I n4 2
Owner Name:..... , • 1 V ..T+'� �G Y✓i i � � r'1'.
..........................................................................
Tine: S3 Printed on: 7/21/2000
O Not O erational O Below Threshold
Date Last Operated or Above Threshold : ...............•.........
County: .. ,v f � 1 ✓1
Phone No:
FacilityContact:.............................................................................. Title Phone No: ...........................
MailingAddress:•...............�..........................................r..y..�........................................................---.................................................................----•............. ..........................
Onsite Representative: JD rljYt t Z.r. ��.......`.!['..fY �....... L-QI .....s........ Integrator: ...!.'1.t/r�•!G y ......................................................�'''
Certified Operator: ........................ . ............ Operator Certification Number ...........................................
Location of Farm:
T
Oswine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
Feeder to Finish -1W14 r7 L(QD JE1 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Z ❑ Subsurface Drains Present JEI Lag, -on Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. 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?
h. If discharge is observed. slid it reach Water of the State? (if yes, notify DWQ)
c. II 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
Su uc;turc I Structure 2 Structure Structure 4 Structure 5
Identifier: ..................
.................. ..............z....---............................. .............. .................................... ....................................
...
Freeboard (inches):D 3?
5100
❑ Yes 'ONo
❑ Yes XNo
❑ Yes ONo
"A
❑ Yes ;W No
❑ Yes PKNo
❑ Yes 2KNo
❑ Yes ONo
Structure 5
Continued on back

Facility Number: 3/ — 73 Date of Inspection D Z 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
�5No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[I Yes
X§ 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
JR] No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
9 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
A No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
/IZ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
L
12_ Crop type S4'!hPAign
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
KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
`
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
A No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
$ No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
DKNo
24_ Does facility require a follow-up visit by same agency?
❑ Yes
Jallo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JdNo
0; Nd -06' aiicjtis ot- defflcienc�es -were n6fed during fhis'viset' - You 'Vi 1.4. -eceKci Rio: futth& .: .
;corresp6ndejce. about. this visit.. • . • . . . . .. . .. ...
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
' _Th rv4 v P`G r.,rQ ✓;� 7D 2 h j u r2 Dc�lG� r Span off' .sue y eoj Li S rs+i
reld 3_
w

Facility Number: 3l - P(3 Bate of inspection 11O Z 1932 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 'J8 No
3I. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;51 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 8No
Additional Comments an orDrawings:
5100
5100

` [� Division of Soil and Water Conservation -_Operation Review. =..
„0 Drvtsion of Soil and Water Conservation ,Compliance Inspection y
Diviision►'ofmater Quality Compliance:Inspechoii
g_ Y - _p ration -Review - -
a 0 _ = =
O#he�-A enc-. O e
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-ug of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection ti0 24 hr. (hh:mm)
Permitted © Certified © Conditionally Certified 0 Registered 3 Not Opera gionalDate Last Operated:
Farm Name: .. �� `� `1......:-i.`' ��................................. ...... County.......��
OwnerName: .............................................. .... ................... .................................................... Phone No: ................................ .......................................................
Facility Contact: .............................................................................. Title:..................... .... Phone No:
Flailing Address:
Onsite Representative: aQ.............VAzz,C........ ...... .... Integrator:
.......................................... ............................. .
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
a`
..........• ...I .... ....................................................... .................................................................................................................................. ....................................--
..............I.... 1 T-
1
Latitude �' �� ��� Longitude
Design. _'; _Curreiit'
Swine Capacity 'Population
❑ Wean to Feeder
Feeder to Finish
�{
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current ,a-Desrgn.-'" Current
Poultry CapacityPopulation Cattle -_ _Ca achy -Population
elation
❑ Layer ❑ Dairy
❑ Non -Layer I I ID Non -Dairy
❑ Other
Total Design Capacity
Total SSL• W
Number of Lagoons .- -7- �` ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdi ..- ,
ng Ponds / 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 or the State? (Il'yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/enin'?
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 Dj No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes jX No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...................................�-�........?:;!�............. ....................................................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes 5�No
Continued on back

Facility Number: 3 — , 3 I.).itc of Inslie Lion
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'? 4
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement"
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehrnprovement'?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
ZT
14. a) Does the facility lack adequate acreacre for land application'?
b) Does the facility need a wettable acre determination?
c) This facility is pended fora 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 Certifier) Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, e!c.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio yiblafigris:oi- defcienct.. were notet3 ditriri# tfhis:visjC • Yo4 witl•Ir•ebd*46 fio further,
correspondence: about this :visit. .:...:.:.... .:.. :... .. • . . .... .
❑ Yes t_kNo
❑ Yes t�No
❑ Yes 9No
❑ Yes N No
❑ Yes VNo
❑ Yes O'No
❑ Yes pdNo
❑ Yes E'No,
❑ Yes No
D(Yes ❑ No
❑ Yes � No
❑ Yes ff No
❑ Yes IsfNo
❑ Yes tKNo
❑ Yes 0 No
❑ Yes NrNo
❑ Yes g No
❑ Yes bdNo
❑ Yes b�No
❑ Yes b 'No
❑ Yes MNo
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
FUse draawwings of facility to better explain situations. (use additional pages as necessary):A.
lGG Lkc
Reviewer/Inspector Name 9 lc) r39_,5 -3�60 o�
Reviewer/Inspector Signature: Date:
3/23/99

facikty Number. 3 - jq3 1 Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
N No
28..Is
there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
rrNo
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) nuted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc:.)
❑ Yes
kNo
31,
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover'?
El Yes
ff No
3/23/99

�► [� Divisiori of Soil and=Water Conseryahon Operation Review,
[j Division of Soil and•, �
v
t5
- Water�Conseivahon Compliance La5pec, oii
= Wivision of Water t ality = ^Compliance Inspection V
A3 Other Agency, Operation Review .- r
0 Routine &Complaint 0 Follow-up of DWO inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection Pg`f
Time of Inspection 3t3 24 hr. (hh:mm)
Permitted [3 Certified 0 Conditionally Certified 0 Registered 0 Not Operational Date Last Operated:
.........................
FarmName: -.... I ``tr.. -'S........................................................ County:.......].! �f?. i..)................................. .......................
Owner Name:....................`L1-<g9)
.................
Phone No: (jQ_ —�"l 7g1�-
FacilityContact: .. 1�-(.�...... ..... .........Title:.............--....--...........-----.-...-..............-- Phone No: ....... ............................................
Mailing Address:
Onsite Representative:..... ` 1...........1.. I-C............................................................ Integrator:... i. �..... r. ......:�
CertifiedOperator:................................................................................................................ Operator Certification Number:..........................................
Locaticnof Far
!h ....... .. .. ... ..............a„J 1���.,-...... ... 7.. .......... �..... 'r r` J? ............-
...............................................
..... ....... �q............................................................................................................................................................................................................. T
Latitude �' �' Longitude
g Design:.. Cetrrent Design Current
-. Design Current:-• '
5wiine Ca acity Population Poultry _'Capacity. Population Cattle Capacity Population ,
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number•of Lagoons �;- - ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding=Ponds /Solid Traps ❑ No Liquid Waste Management System
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b, If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c- if discharge is observed, what is the estimated flow in gal/min!
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure ! Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches):................................................................................................ *.............................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility Number. 3 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ekpplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence bf over application? ❑ Excessive Ponding ❑ PAN
12_ Crop type
❑ No
❑ Yes
❑ 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 (CAW -MP)?
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?
0: �Vo violafipns:or deficiencies -were noteddi>Ht:irigthis:visit: Yott'Wifi rec6iye Rio fucth0! ; :
cor.respoiideni'e:.A"f this visit' .' .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to'quest on #); Explain any YES answers a'nd/or any -recommendations oir any.other comments: -
Use_drawi tgs of facility to better explainsituations (use additional!, pages as necessary) eA
Cam`-,..
11
3/23/99

State of North Carolina
Department of Environment
and Natural Resources
Wilmington Regional Office
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Division of Water Quality
March 2, 1999
Certified Mail # Z 418 221 006
Return Receipt Requested
Mr. Kraig Westerbeek
Johnson-Sholar Farm #1 and #2
PO Box 759
Rose Hill, NC 28458
F."FA
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NaauRAL RESOURCES
Subject: Inspection Form
Johnson-Sholar Farm #1 and #2
Facility Number: 31-143
Duplin County
Dear Mr. Westerbeek:
Please find enclosed a copy of the inspection form for the Johnson-Sholar Farm #1 and #2
conducted on June 23, 1998. This form was found during a routine inspection of our files. I
apologize for any inconvenience this may have caused you. If you have any questions, please
contact me at [phone].
Sincerely,
& � - �' /J(t. - �
Brian L. Wrenn
Environmental Specialist
S: 4 WQS 1 BRIAA W 1 1SC 131-143. LET
127 North Cardinal Dr., Wilmington, North Carolina 28405 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

_-SS r,�:7YY-�f r{�-�•'�M',y:�`�yf7ti�f:rt� �Y""'wV`�,.--....,..:,:ra�.,.,�,....,..�--G.�.�M.[Vlitx:;3. SKr".,...a�s.�e c�;[-�;e:'ChMIS=s��(n(Lj:�t�7r3tw•�„h'a�K%.s��i:,:%-�y:y.. •.+.e' �'�i�%r:::�
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10 Routine 0 Comnlaint 0 Follow-uti of DWO inspection O Follow-up of DSWC review 0 Other
Hate of Inspection /n 23/
Facility Number 31 I .
Time of Inspection 1C 30 24 hr. (hh:mm)
Registered Certified [3 Applied for Permit [3 Permitted 0 Not O erational Date Last Operated:
Farm Name•o�.,� a - harp r 41 tf # L County 1)tJa�
Owner Name: ................... ...... ....... Y.A.YmS...............................
Phone No:....�9IG\ Z8r7-7_iLl..................................................
Facility Contact ! I : Title: -- Phone No: ---...------...
MailingAddress:........ ?.. 11.........SG...:................................................................... ... .0 RJ!� ........................................ .. 5�.....
Onsite Representative:............ { ..... Integrator.......... h : r.1�f...................
Certified Operator: .... :.............................................. ........................................... ................... Operator Certification Number:...................... .
Location of Farm:
— — I � � iiiiii ii i � � � � � � � � � � � � � � � � i i � � � � C
11 �� i i IN III Me
Latitude 0 �:�° 0 �� Longitude 0 �°
❑ Wean to Feeder
© Feeder to Finish
i 3g14
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon' ® Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what'is the estimated flow in 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?
7/25/97
Yes ❑ No
W Yes ❑ No
❑ Yes ❑ No
❑ Yes
[21 No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
PqYes
❑ No
❑ Yes
❑ No
Continued on back

sr:�iw^^ F nTfr" "h • ;i t'i T'xucr a '�y J.w v :r,.r. ,, ,r r v fir;.. �: "tY : -' ;Yri y S n :y,:i' a t', 2�n S: �rYG n v'• 5 ,r-,: ii za '+� •44t .•'t-i'� t�""',iir, ,ii ,�V �3•y,, .t• :*"L - nr�'` ,:'.t}it- ,� �
Facility Numbq: ,31
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ❑ No
Structures f Lagoons,Holding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft)........................................................................ ...............................................................................................................................................
10. Is Seepage observed from any of the structures? ❑ Yes ❑ No
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
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............................................................................................................................................................................................
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?
0 No -violation's or deficiencies were noted during this: visit. You.will receive 'no further
corr6'06ndenO about this. visit.... . " . .. • ... . . :. :.: : • .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
......................................
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments:(refer to question #) Explain any YES answers and/or any reconunersdateons'or any other comments
Use''°drawings of facthty to better.explain situations (u§c additional pages ds,necessary)t
zY(r. ��Jriry WttS { rn�Yl�l�riUni �Uk WAS Ala1ll 'kIt AI�e fn4t
l,,)Oo&:S QtA%� &)c.s 'SYOJJt J�VCC414 ;J'1 o ar UnnGmej +r6tl�vy1 04 &VVSYtCi._{_ Gt••
ft y\% �t'titYo � `1� WW3 S . 'Sc;, -A �.c % Were �,JLu . c-� ''r,', .1 yy i �Qt tJiTCV4r�rc�e-
4 cA C, dowh_&O,rn � C%(\i Op- -La- UtiTY\(m)i 4t "j. 4i1P3 I^1". &j I t4 fee (j
�Iu P ra, DY- �rj 1>a�kt ,1 «t a sh aJ- '�6 5�"r,o,s. t
i�
7/25/97

S
Date of Inspection
Facility Ntitttber
Time of Inspection IU, ao 24 hr. (hh:mm)
© Registered ( Certified 0 Applied for Permit © Permitted Not O erational Date Last Operated:
Farm Name: ........... lov.`w�-...a�C.....K'r!,..... 1... !••Z` •...... County: ......
..............................................................
Owner Name ..........................k1 .��1 ..... :11........VAr!nS............................... Phone No:.... `?� �.z$c?.:dill................. ................ .................
I
Facility Contact: ...............t �.iC� .................................. Title:................... .. Phone No:
MailingAddress:......... p..�F14........ �. �1..................... :...................... ......................... ........R`r�}.....]`........................................ Z.`�.TX .....
Onsite Representative: ..........1.41^........-c.1.............................................................. Integrator: .......... ....�......................................................
Certified Operator: .................................................. ........... ................. :................................ Operator Certification Number:.......................
Location of Farm:
.......... i{h... a...........L..191A..1-0., 5.mi............... 1;..1.`!.{.i:.............................................. ... ....... ............................ ..................
..
...................................................................:.................................................................................................................•----.............------....----...............----..............---................ .
Latitude E=•
❑ Wean to Feeder
® Feeder to Finish
rj
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude
;Design '-Current
Poultry _` Capacity Population Catt
.? ❑Layer ❑ D
❑ Non -Layer ❑ N
❑ Other
Total Destga Cad
Total S
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' 0 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 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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ❑ No
q Yes ❑ No
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
[I Yes [I No
❑ Yes ❑ No
,q Yes ❑ No
❑ Yes ❑ No
Continued on back

rFaci Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? El Yes [I No
Structures tLapoonsMoldinp- Ponds, Flush Pits,etcj.
9. is storage capacity (freeboard plus storm storage) less than adequate? El Yes [I No
Structure 1 Structure 2 Structure 3 Structure 4 Structure. 5 Structure 6
ldentifrer:
Freeboard(ft): .......................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
❑ No
11.
Is erosion, or any other threats to the integrity of any of the structures observed'!
❑ Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers'?
❑ Yes
❑ No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type.................................................................................................................................... .......... ................. ......................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)`!
❑ Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
❑ No
18.
Does the receiving crop need improvement?
❑ Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
❑ No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
21.
Did Reviewer/inspector fail to discuss reviewhnspection with on -site representative?
❑ Yes
❑ No
22.
Does record keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ 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
❑ No
No.violations or deftcieitcie's.were' note'd-during' this.visit.-.You.will receive no further
correspondence about this'.visit.
Comments,(refer'to.question#) •,.Explain any YES answers and/or any recommendattnns or any oilier con�tnents
'
Use'drawings of facility to.better'explain`situations: (use additional pages as necessary).
L& triLJrti c,�aS�c C, � un" ] was 0' l ivl� aiwwcf el� in4
�'trtc-'fit
�,00�S . (,JaS� r.Jc_S S� � �r.�. ar [1nnaYr�e{�1 '�i�f�y •o-� �vcrc�ar�Gr•
<
4,0k �u ri5 `� �,a wo oC� 5 . So,�, ,� s wire. �e �. �-'� '�i, <4 o-
G��y*� ti �f�el'1
UY �seti ikr. 4
+ (4-. � a�Wrz 0. �O,rt o� �y. e P
4L bra r c� 6s. ,% W), A— ahot
7/25/97
Reviewer/inspector Name
Reviewer/Inspector Signature: Date: 2

Division of Soil and Water Conservation Other AgencyRNM
PER
��"
M Division of Water Quality
r, „•., '�� .� _:,� 4. � �.�.-:-,^msanLL a ,�:. ^.*sue•.-...,-�;� :,; =.-� --+°ee�,� .-.�,... � � ��t
0 Routine 0 Com luint Follow-up of DIVQ ins ection O Follow-up of DSWC review 0 Other
Date of Inspection 9i
Facility Number 3 `i Time of Inspection 12 =QA 24 hr. (hh:mm)
© Registered ©`Certified © Applied for Permit © Permitted 0 Not O erational Date Last Operated:... ................ „
Farm Name:........J.0�1t!SW, —.% 4r � -f � Z County:Dv�hr\..............................................................
................I..................... ....................................................
Owner Name:kton.in#rwS..................................................... Pbone No:. 14 ..x 1.-. !. Q.. %..........................
Facility Contact: .�(;l�n». .D.L7.Lr..................... ..... Title: ..... N".,M . ................................. Phone No:...................................................
Mailing Address: P.0.....Eom .....7. ........................ &.� .. .n� .t.......................................... .Z i�.......
Onsite Representative ..... ST4AAi.m............................................... Integrator: .... kv..................... ............. I..........................
Certified Operator................................................................................................................ Operator Certification Number .........................................
Location of Farm:
5..... ff.t`..... ..... : i f.--...ift f .....:I.R-A.3 LL..i...1.... nz� Vroi .....h�£ � ..o.......s....1.`i1.t.............. ............ ....................... A
............. ....... __. ... ........ ..
Latitude 0=1 « Longitude 0 cc
Destgnt Current Design :Current, ry Design Current
P h' Po ulateon ;_Swine' Eapacity Poptilatlon. y Poultiy ^aCapac►ty Population Cattle C 'aei p
El Wean to Feeder ❑Layer ❑Dairy
a.
Feeder to Finish oo '410 Non Layer I ❑ Non Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
El Farrow to Finish' Total D`eSign Capacity
❑ Gilts
❑ Boars
A
to Ta SSL'UV`
1 ,
Number of Lagoons 1 Holding Pnnds": Subsurface Drains Present ❑Lagoon Area Spray Field Area
M` [] No Liquid Waste Management System e
3, bs 1 Zd F._.._
General
K 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 obsen-ed, 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 EA No
❑ Yes 1 Vo
❑ Yes
No
❑ Yes
( No
❑ Yes
No
%Yes
❑ No
❑ Yes
1P No
Yes
❑ No
❑ Yes lei No
❑ Yes If, No
Continued on back

Facility Number: — 43
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Latsoons.tiolditg Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier: ....... ................... ........... .. ............. .............. ..............
Freeboard(ft):........i.:..L.................. ............ ..:3... ... ........ ................................... ..............................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes
f;No
Yes
❑ No
Structure 5 Structure 6
❑ Yes
0 No
❑ Yes
® No
($ Yes
❑ No
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(r-unoffentering waters of the State, notify DWQ)
15. Crop type •-•--•----•.....141i.� Amv/................................................ &A..........
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?
O-No.vialations-or. de'lkiencies.were noted -during this:Visit' You:tivill receive-no-furi er.:
: 0rresp6hdenc6646i t this:visit:
❑ Yes ® No
91 Yes ❑ No
❑-Yes A No
❑ Yes %No
❑ Yes D[No
❑ Yes PtNo
W Yes ❑ No
❑ Yes Q9 No
E,Yes ❑ No
❑ Yes 1A No
❑ Yes No
❑ Yes ❑ No
ir, tf�r4s +rary- over°` ?J co,fibr, a� wr�s �n �elt� 4z.. AL
S. Orvk r._e, pO_P s it S`tri -Nljs SkoA � Srr sSe, otr �W � Pr evlesl?r+�-._�
�o�'v� 1 oon.s ha� i�s� tc`r l �rt=boR•r� atJ1�u�b� I&JWJ 46 t�i ' 0-90 y '"!�'`17
� t� Je i LJ44, c OjKSetjj -
-, 9VV%16,r- &,,�e.o-s an ttw �o a Xe wGii of (4aor` #� [ 56vlrl �, �`"�
` e ����95 b d s .� s nW ws ash ac
� J�� j� f i5W jn sit tnccoj* • iJoS{� ana�v s sha (� IX uPW , IFtc f j �7/25/97
c-ld g
IReviewer/Inspector Signature:
Date:

Facility Number: Date of Inspection: 1 APAI -1
I
Addi.66nal. Qdxiimerits and/or - Drawings.
Ae"-,V,4k �c�►�rt C)ft Inc- s )beCr yyjtjee.d 'It 7-760 &4q0 T R VI& 6F reg6
fk.,- I &,Spon.5 "-T� AAd". ao— Ir., boo %, f .
4/30/97

a -Division of Soil acid WaEet Conservation'= Opeiation Review
- _ 0 Division of Soil and, Water Conservation - Compliance3nspection
J;Division.of Water Quality - Complrance'Inspection,
Other _Agency - Operation Review
Koutine 0 Com hint ollow-u of DWQ ins ection t0 Follow-u of DSW C review 0Other
Facility Number Date of Inspection
Time of Inspection l fie' 00 24 hr. (hh:mm)
Permitted 0 Certified © ConditionallyyrCertified ©Regiµstered [3 Not O erational^,�Date Last Operated:
Farm Name: .............:16'11int..... 6�7 ....1 arm..._. .�---.`� t-z ..... Count 4�1.1> kf-,........... .....................
Owner Name: 3[04 s.1 ....`L YW�..................................... Phone No: _._.. .�a�..l.7VII............................................
Facility Contact: ......... AQ)6N....... ZIMi'.Er............................. Title:...................................... Phone No:...........
Mailing Address: ...........................................
Onsite Representative:..............LAON k.3......... �!!�42r�.................. .. ..................
Certified Operator:.....
Location of Farm:
...................................,................................................ ...... I...................
Integrator:...... .. ..................
Operator Certification Number: ..........................................
............ r....... .. ..V-....5.:1 Q...... af...... R....lgl.t�.,.Q,....,trm.i�I.t..... a?4 f�..o......5..q.1.........................................................................................
..................................................................................................................................................................................................................................... .---
Latitude 0 4 " Longitude ' ' '°
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
LEE
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
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 Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in 2alhnin?
d. Does 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 l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (inches): ...:... ............................................ . ............I ...
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 5 Structure 6
I/6199 Continued on back

FacilityNumber: 3 � 3 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 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 Ai2plication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen
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)?
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?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ict 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?
0: No'vialations or. deficiencies .were noxed during .Niis_visit:. You wrili.rereive na further .: .
•; • eofr-espaidehce;about; this Visit.;.:.:.;.;.;.; .:..:.:.:.:.:.:.;.:. :.:.;.;.:.: :..:.;.;.;.
Comments-(refei to question#): `Explain any YES answers and/or any; recommendations or any_oiher comments
Use drawings of facility. to betterexplain situations. (use additional pages as necessary)-, .
r
1'"D f loo or
a (a f 2319 4 Vrs� f. iao k �`c lviCrtS o f SctmP(� ��in�, avv� K etc t�f�ei
S�YmW itl��Wh�tA{IOr 6,,
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
w
Reviewer/Inspector Name�n� _ _ �Alft G1I\
Reviewer/Inspector Signature: �._6 Date: 1,/z 14 1 11/6/99

❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
O Routine &Complaint O Follow-u of D14'Q ins c-ction. O Follow-u of DSLi'C review• O Other
Date of inspection
Facility Number
Time of Inspection : O 24 hr. (hh:tnm)
Registered © Certified [3 Applied for Permit 13 Permitted 113 Not O erational Date Last Operated ..............
Farm Name: .... .05s...a.1r7.t✓............ County:.......U.�Q.±...................................................
Owner Natne:..A...... C�YYIt..�.......jt��,!4hls.................................................. Phone \`o:...d,(p.. �i�i..4.................-..-.....
Facility Contact: ..� l....2r-w..-✓--.!..,�ctdtll�jZiJitle:... �1�!�'1..�1M ``ti.''!��L✓ Phone No: C11.�...TL:`A.1/7
Mailing Address: ..... DO..wx....-.�........................�..................—.........-..................-..........-............... ..... :...�t�t..p..1-r................-----....................
...�g��..-.....
Onsite Representative:....Ak6e �.--...-5,4 a;A.�!`....................................... ........ Integrator: J.�.npk ...............................................
Certified Operator:............................................................................................................... Operator Certification Number .........................................
Location of Farm:
..,..(Lx.M....... 15.....O n.....rXr 1A.....51 ..... c......Sh...i9lfu.1.....�.mi1.c:...... t:�ot*wes.....af..........T.L..1AL!....................................................... A
.............. ........ ..- ...
Latitude Longitude �• 0` ���
Design= Current r> Design Current Design Current
Swine
Ca Pact Po ulattoti Cattle _, Capacity Populatton y:
apac}ty Papulaf,on ,' Poultry p ty p
❑ Wean to Feeder
❑Layer
❑Dairy
`
® Feeder to Finish
❑Non -Layer
❑ Non-Dairy
[I Farrow to Wean
n m.
❑ Other y
Farrow to Feeder
[I3
��a
❑ Farrow to Finish
f
Total Des>Ign Capacity
❑ Gilts
H
W; n TotaI:SSLW
3
❑ Boars
y ,Number of Laa�oons / Holding Ponds ❑Subsurface Drains Present Magoon Area pray Field
AArea
fr 3 ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: El Lagoon MSpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? UYes ❑ No
b. If discharge is observed, did it reach Surface Water? (If ves, notify DWQ) eyes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
-d. Does discharge bypass a lagoon system? (lf yes, notify DWQ) ❑ Yes eNo
3. Is there evidence of past discharge from any part of the operation? VYes ❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Vio
5. Does any part of the waste management system (other than lagoons/holding ponds) require ETYes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ❑ No;
7/25/97 Continued on back

Facility Number:3 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes"No
Structures (Lagoons,11oldine Ponds, Flush Pits, etc.) �/
9. Is storage capacity (freeboard plus storm storage) less than adequate? LDS Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................
♦ t/
Freeboard (ft): ............. I..... ...............
10. Is seepage observed from any of the structures? ❑ Yes [�Ko
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 2<0
12. Do any of the structures need maintenance/improvement? ❑ Yes 'f' 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?
waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
de
15. Crop type ...................... ......................�f.-...-.................1WjL9f..........-.................................-
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?
0 No.violations,or. deficiencies. werenotedduring this:visit:-:Y.644ifl receive-i o-ftirther-
: correspondeh&c about.this:visit , " : -
❑ Yes 2<0
O Yes ❑ No
❑ Yes ❑ No
❑Yes [INo
& ,/ Yes ❑_,/No
❑ Yes p� No
0Yes ❑ No
❑ Yes iN o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
aof�c,cJ to kc nog
•6vse+r�.JknSvdn- ParCar1� La-!0a�v
COVr,-Grop olari;rcj we.6+e—. O11 wcr-G +k-d Y-a"Seal
/zryW ho a_P j2A
y
4LL StPrc.19U'h. 11-1krossk 4 4e/fae— be.rn.L
0. �1, P4 No N� ��G trC .`^► j 1v .. Le. 4 6 p e _ 4 f jo a e—r—M 4L., to e—
.�? v ,�,�
T N,4 5 t`!oc—,,^5 v �T ��1e .-P; et( " o/ e_ 4'k&-
v< ct U M 1- as v 0, ^ G✓'6e k D r �+ a H d ..S Yl e)(+V i
7/25/97

❑DSWC Animal Feedlot Operation Review ��� "�� `�°���"�`
.®DWQ Animal Feedlot Operation Site Inspection
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection 2 j7
Time Inspection i 1 i d za hr.
of (hh:mm)
Registered E3 Certified 0 Applied for Permit
© Permitted 0 Not O crational Date Last Operated:..........................
Fartn Name n 4 74'
tn..Y..�ro r
#Z County:.........Dv�.hrl...........................................................
Owner Name: (1l).11 l rr .. Phone No:..�1.(U.,�.. zr..:.zll 1...............
�..........lLl7!r.l.l�....... CCsY.tY7t............................................. ...............................
ii
Facility Contact: .....1��(.....Sk?x?? ...............................
Title:......[vltt�at� ... .... Phone No:.��i.i�?�..Z`.�?`.7(a..........
14tailingAddress: ..... �G.... i?St7�... . 1................................
u.....t...
......................................... ........ ...11!..t�..i..i�i`r...................................... .. -.5.V ..
Onsite Representative......... 1.k3�i ----- fv:�...................................................
Integrator.........1 `. 1
rNumber;...................
Certified Operator:..........................................................
. Operator Certification
Location of Farm:
�..Twx�.,��.. '.ar.. ..... �Q ,... SC�in..,.Ac#.... �►atl.i�...... ...I~~ ...air......... it+t .(ll.... �
S�ott`�tSn x..............?r.-... �` i�....Q.r.-.-a...�,191.r...�. �e `i1.ta.....s...3...C?: '!s...
I o4i4,. •la 1 1� E i, E Ica 1cc Sr 4- (eff).
Design Current
Design Current Design:- Current
Swine Capacity Population
Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
I0 Layer JE1 Dairy
Feeder to Finish g
❑ Non -Layer ILI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
JE1 Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
❑ No Liquid Waste ivianagement System
General
I . Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon El Spray Field ❑ Other ,.
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q 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 �41allinin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
KNo
7/25/97 Continued on back

r Fpcility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure. 5 Structure 6
Identifier:
............. ... ti........ ....... �....5 # L.......................... .............. ............ I ............ I.-......
Freeboard (ft): ..........,Z :.z................... 3 •.
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? D "Yes ❑ No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(1f 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
RNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....................... n.Gxu......................................... ......................................... ..............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18- Does the receiving crop need improvement?
® Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
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
Ej No
22. Does record keeping need improvement?
®Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
RNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
0• No.violations or. deficiencies. we. re- noted- during this-visit..You.will receive -no further
... • correspondence about this. visit'.-','
Comments (refer to question #) Explain any YES answers and/or any reconimendattons or any; other -comments.
Ilse drawings of facdity_to better explain sifuatiQns. (use additional pages asmecessary) W _
rvns �)ip II .skout) be, OlUd mse-.ee of` GarvVCrieJ +o
c` c�rasSer} W cW tray = +- + p { }
11,112. Gr ibf� or IV%e Ar-1 oU {+ �" / 5 ( SV,Ov�J Ix F d C� Gil Epp `J{
Eros bra or\ cw4r- wolf of ( r v„ # L Stiou ? be f--1W to*- c f ay a.•J ,^ese fde)- k burr,, s��adt�
l)e bt)i R a�•oog3 luo-dor ov\ �o�c�oan i�(, k,\vjW wo-II o� }a�con #t sha�l� fie maod
it- W;v4"r crop 1'�c� doe rfa et) fie re - 1Jo,o C_ML� �n kdS - f 4" I
2 No W(kS 1J \ E 2 a aY1 �lAi� -Y m i v� rtKe 5 S a Ger i�fii Cfn�1 ert .f�A Soy a r01'-bs Sci z
�
av�{v Si s sG1ov �>}t�n - 5 lticcx�P� �� are �
ly
Lbrn rabe�e� �lhtcin um p ! 7/25/97
Reviewer/lnspector Name ; ` `
r
Reviewer/Inspector Signature: Date: $` ZZ

Site Requires Immediate Attention:
Facility No. �J-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �' 3 1995.
Time: 10 35
Farm Name/Owner: &) Ol Z Y �S
Mailing Address: 5�e 'etj 652. ( r 0-Ly 4s?
County: %I?__ --
Integrator. bJrnh(A,' FW&15 Phone:
On Site Representative: �UC.� '5Ynl 2►r Phone: Z$ `- '�KXCOO
Physical Address/Location: 1I) e65e 1�' 1( — 1915, 1 e `F� opt 19i(0
' 4 n�,. Gh i2�~�� n�
Type of Operation: Swine Poultry Cattle 'i n te7cj
Design Capacity: �JG �- Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number. ACNE
Latitude: 2' 4- ° 52 ' �3+52" Longitude: -1$ 01 ' 2�-Z " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: Z- Ft. 0 Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Ye or No
• Is adequate land available for spray? Yes or No Is the cover crop adequate? Desr No
Crop(s) being utilized: 6e_rmcJ�Fe-sc e-
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& 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 o No
Additional Comments: &05 t can o(\ z: tw Corn e r
h12/! Q '/I r fi (�� r 2j�2 r 2tr/I
L 2
Inspector Name Si;nat
cc: Facility Assessment Unit Use attachments if Needed.