310165_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental dual

1 ( ICI l i,
Type of Visit: Q Co md fiance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance I
Reason for Visit: O Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: j o Departure Time: / o County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
/ Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Integrator:
Certification Number: 1 l S-9 y �—
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design C*urrent
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish 4 r37
Farrow to Wean
Farrow to Feeder
mpissian
D . P,oultr,
Ca aci_
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 D"tTZ-0 NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes PNoo
NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Date of inspection: 3
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?
Structure 1 Structure 2 Structure 3
Identifier: "l S
Spillway?:
Designed Freeboard (in):
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Observed Freeboard (in): `Z r% 2 T `2-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EYNo
❑ 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
[;TNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E!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
[Z�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
Cj No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
E�<o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[JNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I__I No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[T No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'1�o7
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F5 No
❑ NA
❑ NE
Required Records & Documents
l";
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
TNo
❑ 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 eNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facile Number: jDate of Inspection: l7
24r Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Pj'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check es ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
A �[] Fail o complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Fall
sludge levels in any lagoon r2
List structure(s) and date of first survey indicating non-compliance: ..J's=� F F3,
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E2'NAB❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes To ❑ NA ❑ NE
[:)Yes No ❑ NA ❑ NE
❑ Yes V rNo ❑ NA ❑ NE
❑ Yes CZrNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E�rNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �N/o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑'NO ❑ NA [_] NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other, comments'.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7 ' t1
Date: �� r
214120l S

Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: 01 routine Q Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Ir Arrival Time: Departure Time: L_:1J.� County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �y C_If
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: I t 9 Cr _$
Certification Number:
Longitude:
Design Current
Swine C►►specify Pop.
Wean to Finish
Wet Poultry
Layer
Design Current
Capacity Pop.
Design Curren
Pot
Cattle Capacity p.
Dairy Cow
Wean to Feeder
Non -La er
Design C►urrept
Ca a_ci_ Pao
DairyCalf
;Feder to Finish
0 1 0�
D , Poultry
DairyHeifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 4,"o ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[-]Yes
0 No
❑ NA
❑ NE
❑ Yes
To
❑ NA
❑ NE
Page I of 3
21412015 Continued

dC
Facili Number: - Date of Inspection: 7
2�
aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[D-K° ❑ 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: -3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E],io, ❑ 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
0'❑ 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 No ❑ NA ❑ NE
$. Do any of the structures lack adequate markers as required by the permit? ❑ Yes NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes I__ Xo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[] N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑/ " f�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[3No
0 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[i]`No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes D-111 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑]NNNoo [DNA ❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: - Date of Inspection:
24. Did the facility fail o calibrate waste application equipment as required by the permit? ❑ Yes [D'T'o ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ETNo ❑ 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 e' o ❑ NA ❑ NE
[] Yes ❑ No [ K-A ❑ NE
❑ Yes C] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 7 ❑ NA ❑ NE
El Yes 4 " � O ❑ NA
[:]Yes [j No NA
❑ Yes No ❑ NA
Comments (refer to question #): Explain any YES answers.and/or any additional recommendations or any other comments. .
Use drawing -of facility to better explain situations (use additional pages as necessary).
c9Cjvo
C �-'' �'•' ""Q� 490 of cc IL o „S Q
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
.klL�i_ V c� --e
•-L cXlG
❑ NE
❑ NE
❑ NE
Phone: (D 7 % 6 73a i
Date: , z�
21412015

Type of Visit: (:3'Com iance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I //2 //S1 Arrival Time: QS Departure Time: County: Region:
Farm Name: ` Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
apacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capty . Pop.ean
rPF,
to Finish
La er
Dairy Cow
can to Feeder
Non -La er
Dairy Calf
eder to Finish
airy Heifer
rrow to Wean
Design Current
D Cow
rrow to Feeder
to Finish
Dr, P,oultr, Ca aci P,o ,
La ers
Non -Dairy
Beef Stocker
lts
Non -La ers
Beef Feeder
!Farrow
ars
Pullets
Beef Brood Cow
her
Turke sTurke Poults
Other
Dischar es and Stream Impacts
acts
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 a<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

f acility Number: Date of Inspection: Z _F
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �NoEj ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [2/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [E Yes [-]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes CJ N o ❑ 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 �E
❑ 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? E Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA 641�
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA E3�NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA E]�NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA WNE
E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA
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 E
❑ 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 SWN
,
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [:]No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA
Page 2 of 3 21412015 Continued

Facili Number: 31 - 16 Date of Inspection: 2 l S-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA �NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA �1
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA MINE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No U NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [:]No ❑ NA [g'NE
❑ Yes Eg<o ❑ NA ❑ NE
❑ Yes [] No [] NA [/NNE
❑ Yes ❑ No ❑ NA E3 NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? QWes
No
❑ NA
❑ NE
❑ No
C3<A
❑ NE
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any,YES answers and/or any additional recommendations ar.any other comments.
Use,drawings of facility to better.explain situations (use additional pages as necessary).
htiCf 1bdal, k-r fe is s�1c`J/ Pe r Jte4tL� PP/�,`55,
C/ oti�r r-TE�sd� �o lln�orno
7J1f�� Coti`��q / )�'e / IMP -or,-[.
�r 1 l . f e ,q 10 1,
vN-o
Reviewer/Inspector Name: 0 k � 1L. 00 'A 6
Reviewer/Inspector Signature:
Page 3 of 3
rT SS Co
Phone: \ 7.3 P T
Date:
21412015

Type of Visit: fO Co Lance InspectionV Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Z `( —Arrival Time: D 3 Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: V�'t
Certified Operator:
Title:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pap. Wet Poultry Capacity Pop.
La er
Design C*urrent
Cattle Capacity Pop.
DairyCow
)yEan to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
1101j, 11.9oo
Design C►►urrent
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
1) P,oult_ry Ca achy P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes ❑ N ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
E y�
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page l of 3 21412015 Continued

Facili Number: - Date of Inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LJ 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: Z �_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [—]Yes [] N ❑ 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 To ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes LrJ 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 ETNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [a -No
❑ NA
❑ NE
maintenance or improvement?
11. t there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ErNo
❑ NA
❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P�Noo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need ' provement? if yes, check appropriate box below. 4 '' "❑ No ❑ NA ❑ NE
❑ Waste Application Weekly Freeboard Waste Analysis Soil Analysis ❑ Waste Transfers eather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Efjlvlonthly and V Rainfall Inspections ZSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes l3 "'9 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F]/No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Ds ection: `i
4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below. YY
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ff'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes C� No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes E rNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
No .
❑ NA
❑ NE
FTNo
❑ NA
❑ NE
Reviewer/Inspector Signature: w �C ✓1� �. Date: ?,Ile Y/�
Page 3 of 3 21412015

r�
(Type of Visit: U4e-e mpliance Inspection U Operation Review ()'Structure Evaluation () Technical Assistance I
Reason for Visit: 0 Routine 0 Complaint ollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1-1 l Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: eU r ' t G t 04 � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
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
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
'DairyHeifer
Design Current D Cow
Farrow to Feeder
Farrow to Finish
D . P�oult . Ca AN-Plo , Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Q.t
Other
Turke s
ey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [AT- ❑ NA ❑ NE
❑ Yes [:]No ❑ NA' ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
C3155
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

[Facility Number: 7 - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El -go' ❑ 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: Z_ :fit
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J Z�
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
ENo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
EErl�o
❑ NA .
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ej­Ro
❑ 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
[ o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
[i3`NE
❑ Excessive Pending ❑ 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
[3-3�fE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
i__I ""-
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
[31fiE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[!j_NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑-11TE_.
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[ 3 E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
EJ—NE
the appropriate box.
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
E
❑ 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
❑ No
❑ NA
E] NE,
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
fE
Page 2 of 3 21412015 Continued

Facili Number: - & 1 Date of Inspection: 2 (41 El
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [ -NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA []rKE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA l=J E
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
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
0_o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[—]Yes
[:]No
❑ NA
ETiJE
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
[3 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
J 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).
Oi'A- t ;r -ftrdvi4,
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: A (o -7'7f,
Date: / 5
21412015

13ivrs.
Facility Number: QrDtvts
Q`Othei
�n, of _Water uali w
�n ofSoil andrWateraConservahon�`"
Type of Visit ( Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit P46utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 5- S— ( rrival Time: Departure Time: County: Region: W ! r
Farm Name: Owner Email:
Owner Name: -.:,L- i-i/�i�'1� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C r
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = i Longitude: 00
= g
Design Curren�^ `Design; Current; :.Design Current
`Swine�a aci Po`"ulation WetPoultry `Ca aci.'Po ulahon,Cat[le
C p ty p P tJ P Capacity Population .,
-
❑ Layer
❑ Non -Layer
:. x• .;
t;
_
�. �. _�-:
Dry Poultry
i
wOther:
-
z" ❑ Other
�` f o uctures
Number t
LI E3
. ' .. I.... - 1.
;�� ❑Wean to Finish
'El Wean to Feeder
El Feeder Finish
to
Farrow to Wean
❑Farrow to Feeder
❑Farrow to Finish
❑Gilts
Boars
❑ Layers
❑ Non-Layer-5
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stacker
❑
Beef Feeder
❑
Beef Brood Co
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,�No ❑ NA ❑ NE
[]Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Off No
❑ Yes
XVFq[-INA
❑NE
❑ Yes
❑ NA
❑ NE
Page 1 of 3 I2/28/04 Continued

Facility Number: 31 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j6NO
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 j2rNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes XNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes JZ'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 ;?fNo ❑ 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 F(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 0"No ❑ NA ❑ NE
[3Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or'anyadditiogal recommendations or any other comments.`
Use drawings of facility tobetterexplain situations.(use additional, pages as:necessary) ,-
�r C..�
s
4re,4j,_,, 4,k., 5ecc>
la oar t r 1'�
J� ��� l� g... l4� Dart 2
4o C ¢mob Ir�a - ram ou j- dZ 11,sper n
Reviewer/Inspector Name: v L.Phone:" 7�G 1_77?
Reviewer/Inspector Signature: �� Date:
. q //.�— // 2L—
Page 3 of 3 4/ 011

Facility Number: - Date of Ins ection: L
Wasto Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZf No
a. If y4the
in�oth structural freeboard?
3'k�Structure 2 Structure 3 Structure 4
Identifier: Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):5. Are there any immediate thrgrittyy off anyy of tof the structures observed?
(i.e., large trees, severe erostc.)
❑ Yes ;3 No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No
❑ NA ❑ NE
6. Are there structures on -site which are ndt properly addressed and/or managed through a ❑ Yes El 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 PIo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes T[�To
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) TT
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? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Vf(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 J21'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 4ffNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 9,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes JZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes T!rNo
❑ 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 L�rNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes A!fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Prl�o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Type of Visit: O Co fiance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer -lob kDeparture Time: '3o County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ?&T c l C 9c LL,, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: V 4 P 6
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Nan -La er
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. l;o_uit ,
La ers
Design
C•_a aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
-a.—Was the conveyance man-made?
b. Did"the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
[:]Yes VNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Faciliti-Number: - W.71 Date of Inspection:
3 --
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes INO ❑ 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: 561Q-,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J% 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes:No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 in 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 Cl No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 4EI o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 2�'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ENo ❑ 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? �res No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 7No
❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ 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 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 ONo ❑ 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 which the CAWMP?
Yes NA NE
problems noted cause non-compliance of permit or
❑ , ❑ ❑
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ NA ❑ NE
VNo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations:.or any other comments. -, ,
Use drawings of facility to better explain situations (use additional pages as necessary).
a �%) GAT 5t_.o0 -C ?QA F2 CA 6.o� 6Q-CC, 7,-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( �j
j4 6 •- p
Date:
2141201

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 ❑ Denied Access
Date of Visit: Arrrival Time: r parture Time: Q' ounty:
Farm Name: Af= Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
®
Onsite Representative: Y
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: &14or I
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = c 0 « Longitude: = ° 0 6 0 «
Design Current Design Current -
Swme Capacity Population VVet Poultry r `Ca aci Po alation,: C'ai1
_.. P„ _yty . _ P- .
=JLJ
Wean to Finish
I
LJ Layer
❑ Wean to Feeder
❑Non-L�
's
❑ Feeder to Finish
D P
="
❑ Farrow to Wean
❑ Farrow to Feeder
❑Farrow to Finish
❑ Gilts
N
❑ La ers
❑ Non-L�
❑ Boars
a
r
❑ Pullets
Other
❑ Turke
❑Turke
❑ Other
❑Other
Poults
_ _tjU Dai Calf
—�T'JUDairyHeifer
"= ;. ❑ Dry Cow
Discharees & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
U Beef Stocker
❑ Beef Feeder
❑ Beef Brood C
.� PlurnberMo
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 P'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Oio
❑ Yes
O'No
❑ NA
❑ NE
❑ Yes
,B No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facili Number: Date of Ins ection: ,(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes Z No ❑ NA ❑ NE
Structure I Structure 2 Struc e 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):11
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes allo
❑ 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 Pa -No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes O[No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes �TNo
❑ 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 P-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ;E:f'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes )�3No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes .2) No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;�FNo
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes J2^No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes g3-No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gNo
❑ 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 .5140
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P�N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection: /
24. id the facility fail to calibrate waste application equipment as required by the permit. Yes [:]No ❑ NA ❑ NE
Is the�facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes LTNo ❑ 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? .n9 Yes FNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E] Yes p`&o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ;2-No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concem? ❑ Yes Zr 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 fi�!rVo ❑ 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
;EJ'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
�]7No
❑ 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, ., s
Use drawings of facility to better explain situations (use additional pages as necessary).
S _S oC-/
CJ
Reviewer/Inspector Name:
Phone: Y1V _1 b
Reviewer/Inspector Signature:
Date: v//////
Page 3 of 3 21417011

IType of Visit Compliance 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:41w;;Z'7z�
ArrivalTime: �'GG� Departure Time:
f� County:
Farm Name:/i�tS' '7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: '
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: :{ l�
Latitude: = o = 1 = « Longitude: = ° = 6 = «
Design Current.IT
Swine - k Capacity Population Wet I'oitltry
❑ Wean to Finish " ❑ Layer
ElWean to Feeder Non -Layer
r ❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
''Others-.
. tl
Current-
❑ Layers
❑ Non -Layers
El Pullets
❑ Turkeys
❑ TurkeyPoults
Li 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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
numoer-ort;
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 O'No ❑ NA ❑ NE
❑Yes
❑No
[I NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ONo
❑ Yes
1�_No
❑ NA
❑ NE
❑ Yes
�?No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —2 C_:�' P
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes '�] No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ,ETNo ❑ NA 0 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ YeslEr�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes JNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes /El"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P, ro
❑ NA
❑ NE
Comments (refer to question:#)- Explain any YES answers and/or any'retom.menda#ions or"any other comments k: �
�,
Use•drawings of facility to better explain §ituattan`s {use aiidittona[ pages as necessary)
T
Reviewer/inspector Name e `�^ Phone: r,�, 7
Reviewer/Inspector Signature: - Date: 06
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
` Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes QNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0 Yes 0"No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
allo
❑ 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
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
YNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[J No
❑ NA
❑ NE
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
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
�2"'filo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PMo
❑ 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
fNo
❑ 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
[I NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
f
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E]'Ko
❑ NA
❑ NE
Additional Comments and/orr.Drawings:
1404 A/
(0 V-
csv��U � 3 5 10
v CL bye.
Page 3of3
12128104

Type of Visit tE�F'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit, htoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / IO Arrival Time: Departure Time: County:
dr
Farm Name: r Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator• "
Operator Certification Number:
Region:Z4�,TJ
Back-up Certification Number:
Latitude: = o Longitude: = 0 0 t = «
Design Current.p�DestgnCurrent Design
Curen t
Swine
Capacity Population Wet Poul "" ` t+:n�
hY
rr ',
Cede: Eapacity Population
..
❑Wean to Finish
_ -. ,.�Capaci�ty �Populahonf
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
El Feeder to Finish
- "„r .-..
❑ Dairy Heifer
❑ Farrow to Wean
Dr"yMPoultry
❑ Dry Cow
El Farrow to Feeder
: ,
❑ Non -Dairy
ElFarrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑Boars
�= El Pullets
[IBeef Brood Co
--- - — -
- El Turkeys
Other=�
Q Turkey Poults
❑ Other
❑Other
Number ofStrtictures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
J: No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,EfNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
I[J No
❑ NA
❑ NE
other than from a discharge!
12128104
Continued

Facility Number: 31 — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [INo ❑ NA ❑ NE
Structure l Strure 2 Struc re 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 )Z No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P 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
6 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)
f—'
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
ElNA
ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
VNo
❑ 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
eNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FPNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
�f No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ViNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
YES.answerndammenaCamments (refer to_quesd�y.her c#oiommeats.,5
Use drawings of facility toabetter explam: situations . (use
_'
additional:pages,as :necessary,-).
ReviewerlInspector Name
Phone: -�
Reviewer)lnspector Signature:
Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;YNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VrNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
I/No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P�No
❑ NA
❑ NE
Other Issues
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ 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
VNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
INo
❑ NA
❑ NE
Additional Comments and/or Drawings:
ok C e iAe c'l W c-- b All
E)U(?. 4-s
Page 3 of 3 I2128104

_ tj Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation.. . t'110"O'
M2 — 0 Other Agency
Type of Visit �mpliance 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: p1 (/ Arrival Time: IQ 1 v Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o ='
= Longitude: = o =
Design Current Design "' Current
Swine
Capacity Population Wet Poultry ' Capacity.., Population
': ❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
ILI Non -Layer
El Feeder to Finish
"' ❑ Farrow to Wean
i :Dry Roultry
❑ Farrow to Feeder
ElFarrow to Finish
❑ Layers
Gilts
Other
❑ Other
L_
Pullets
Other
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
D'egign Currei
Cattle Capacity'. Eopulati
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures '
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �TNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ifNo
❑ NA
❑ NE
❑ Yes
Z"No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ET'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): , 3 7
If
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes -ETNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes _01 o ❑ 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,-f:fNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo
❑ NA ❑ NE
maintenance or improvement?
WasteAmilication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,ONo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,I -No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes P No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �fNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ONo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
3o7,—
�l� 6vazl r� c�r�s' xe_e�irz s
Reviewer/inspector Name �{��� t/` �� Phone: ZV
Reviewer/Inspector Signature: Date:
12/2R/0 Continued

Type of Visit z-0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ORoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: % 0— Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Z4 7 Owner Email:
Phone:
Facility Contact: p Title: Phone No:
Onsite Representative: kZZ �J-OIntegrator:
Certified Operator: Operator Certification Num er:
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
Back-up Certification Number:
Latitude: 0 0 = 6 = Longitude: ❑ o 0 ` =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
J3 No
[:]Yes
,0 Ro
❑ NA
❑ NE
❑ Yes
J�No
❑ NA
❑ NE
12128104 Continued

Facility Number: 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
St ru� re 1 Structure Struc Stryctu 4 Structure 5 Structure 6
Identifier: / Y�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cr p " ��wl
❑/EEviidennce of Wind Drift El Application Outside of Area
12. Crop type(s) r�. 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 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):
7 Anea /
10 ®47s_; S<r`rn C94` pl"tsq
Reviewer/Inspector Name U 11 G�f�/(j�� Phone:
Reviewer/Inspector Signature: Date: G
Pape 2 of 12 R/Od C.'ontinaed

a
Facility Number: 31 -- Date of Inspection
Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [--]Yes AD No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EINo ❑ 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?
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?
❑ Yes Q`No
❑ NA
❑ NE
❑ Yes ..0No
❑ NA
❑ NE
❑ Yes JZNo
❑ NA
[I NE
❑ Yes [TNo
❑ NA
❑ NE
❑ Yes 'P]'No
❑ NA
❑ NE
❑ Yes 10
❑ NA
❑ NE
❑ Yes
Mo
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
12TNo
❑ NA
❑ NE
❑ Yes
EJNo
❑NA
❑NE
El Yes
El No
[I NA
[I NE
Additional Comments and/or Drawings:
y Cy
(3
'A 0 Cy
0.6
L19 C�{,
Page 3 of 3
12128104

Type of Visit .Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10�4outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �[.L!-'� Departure Time: County:
Farm Name: --'�? — Cl—Owner Email:
Owner Name:`! "OF Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: .&�t4&&
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: %. '
Latitude: = o = . 0 « Longitude: = ° = f =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other — ._.... .
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: =I
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 PTNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
El NE
❑Yes .❑lN+o
❑ Yes XJ No
❑ NA
❑ NE
❑Yes; -
DNA
❑NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes J:l'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Struc urc I Structure 2P 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 a No ❑ NA ❑ NE
(ic/ 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 2No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes elfff'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P-No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Po ❑ 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 indow. Evidence of Wind Drifl ❑ Application Outside f Area
12. Crop type(s3�r_� 'r
) C �G
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes L'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes J[2'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
Yes Lallo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ;6No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? -'
❑ Yes Z No
❑ NA
❑ NE
Reviewer/Inspector Name
Phone:
Reviewer/inspector Signature:
Date:�-
12/28/00 Continued

Facility Number:,?/— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
❑ Waste Application /ET_W�eekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
'),ErRainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections onthly and 1 ° Rain Inspections ElWeather Code
epAl
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes �❑i `No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes .ErNo
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes Li No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ,❑i'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes OIL
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [:14o
❑ 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 o
?N
ElNA
[INE
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
[I NE
General Permit'? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
,721 ?)ease a>eco r 1pr-ee bo a r �- fa ti "l �
� d�
�` 1 f laa�Yr 1n n
�ee cord Coo-c
r
7 lenel ld crw _Z: �rk...Vl©.r-T
12128104

Date of visit: 2z O Time: L.J
Permitted © Certified [3 Conditionally Certified y0 Registered Date Last Operate;tpr Above Threshold: ------- ..... .
Farm Name: ........... /' PQz.J/'i..'!h®�7 Co.,. _ ............� _ .. _.
Owner Name: 1L f�lF� Phone No:
Mailing Address:
Facility Contact: ..�....... ..........._�. Title:...................._........................._.^...... Phone No:...... _... ..� _ ......
Onsite Representative:...„.' ��.--�f!_.. . Integrator•.
Certified Operator:
Location of Farm:
Operator Certification Number: ..........................................
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 69 . Longitude • 9 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ZNo
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 gaUrnin?
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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;2rNo
Waste Collection & Treatment
4. Is. storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Structure I Structure 2 Structure 3 S cture 4 Structure 5 Structure 6
Identifier: Z
Freeboard (inches):
12112103 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 ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes ,ONo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 2rNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ;2"No
9. Do any stuctures Iack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes ONo
elevation markings?
Waste Application_
10. Are there any buffers that need maintenance/improvement?
❑ Yes XNo
11. Is there evidence of over application? If yes, check the appropriate box below_
❑ Yes ,ETNo
❑ Excessive Ponding ❑ PAN Hydraulic Overl ad ❑ Frozen Ground Copper and/o nc
12. Crop type zLa Qv�25F-��}
13. Do the receiving crops differ with those designated in tde drafied Animal Waste Management Plan (CAWMP)?
❑ Yes ,O'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes gNo
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 gNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes gNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes gNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes jdNo
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 )R(No
Air Quality representative immediately.
Cammeats (refer k ques#on,,#) Ea gWid any YES answers anchor aap reComlricadativas or an other Co r
Use drawings of facil,ty t4 better explain sctuatioas: { $ddc pages as neces ary} i ❑Field Copy ❑ Final Notes
�- _
_.
23 ,gry,�J ►�Po�
EG
/} �O20 5. (i�Iiie?1,vP3 -re? 3`Wd3l
*tJE ED fo i" E Ep �i./A� L- y kA-'2-rJ F(�tC_ A 7-0 l�I��Q`�
M OQ Wry S
�t�p r.� e r�pr.Is �N
Rf QROjE13 FoRrnS •
` j�FFFf� o USE TRP--1 FORMS (H� � CAS fi OLrA PFRrz ,
J�Rc ( Vf_;SP ��tRPay S; ocrzn0C �E T -7FR I.C--rN
1��Gom�Ec�� � FrFPzNC�_ Z4zC-fN7Z-0J
Reviewer/InspectorName�r-�-
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: -1/ Date of Inspection
Reatuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ;�No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes No
(iel VaT, checklists, design, maps, etc.)
,f
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes gNo
❑ Waste Application ® Freeboard ❑ Waste Analysis B Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes PTNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes J�rNo
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
28. Does facility require a follow-up visit by same agency?
❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes WNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
OYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ONO
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes JZNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes J9No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ONO
35. Does record keeping for NPDES required forms need improvement? if yes, check the appropriate box below. Yes ❑ No
❑ Stocking Farm ❑ Crop Yield Form 0 Rainfall A Inspection After 1" Rain
0120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
W-45GlJfrs � fL
�jP�Gz Ci9-7 Zv•� %�RF
��o�� Cfer"ssz�f
�r,Ji✓F2
'p A y 6k EFr/G
-/llQT� : �rlF���r��'.-� /-� Ste' �r� �UErP. �EL'a,2p 5 /1%/` i4-7 J�i✓�
r !7/i✓E
1.
12112103

Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification q Other ❑ Denied Access
Facility Number Date of Visit: �.-�= J Time:
Not O erational 0 Below Threshold
0 Permitted 0 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold-
Farm
t LL ` r
Farm Name: ��// �lT�-�i5��1/�G. f��'i°� �Z"� County: !%ltf7 i -t
Owner Name: ��f�G� /� Phone No:
Mailing Address:
Facility Contact: Title: /,PhoneNo:
Onsite Representative: OGJ?Q✓ Integrator: /U�' ?/2: f_
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ° K Longitude * G OK
-Design Current , Design Current Design; Current
Swine Capacity. Population Poultry Capacity Population Cattle,; CapacitV Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish I l/ ❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean — -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish T6tal Design Capacity
❑ Gilts
ElBoars Total''SSLW
_ _.;
Number of Lagoons �;; ❑Subsurface Drains Present _❑ La on Area ❑ Spray Field Area
'HdngPondseS❑o Liquid Waste Management System oTaps
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of 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: �21 _71
Freeboard (inches): 2
05103101
❑ Yes f LNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
Q� Yes ❑ No
❑ Yes D4No
Structure 6
Continued

Facility Number: 3 -/6§- Date of Inspection 3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [:]No
(If anyof questions 4-6 was answered yes, and the situation poses an .
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do anv stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
_Waste Application
10. Are there any buffers that need maintenanceiimprovement? ❑ Yes ❑ No
11. Is there evidence of over application? I&Excessive Ponding ❑ PAN ❑ Hydraulic Overload KYes ❑ No
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal [Waste Management Plan (CA A MP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ U'UP, checklists, design. maps. etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) [I 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
97. Fail to notifi-- regional DWQ of emergency situations as required by General Permit?
(ie/ discharge. freeboard problems, over application) J�R Yes ❑ No
23. Did RevieweLgnspector fait to discuss review•linspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
113 No violations or deficiencies were noted during this visit You will receive no further correspondence about t5is visit.
Field Copy y ❑ Final Notes
l�itrG %5 c 16r/ xret /eh 4e SN/'a/ ♦elGl 4// A V^t'i /p ,4t[�@ Ale -en aw
CIrG°a dU�/C !!/�S ��G�tsF/Ci Y,L LIDkJi�//Ot 7�d L�/�TG'/S s7:�7�G �� G�iSGW f ye-
�/L1 06�0 �1c4/� � •�i�Q /47' i rr ���w
i"3 Idjtn l.Je_ e leeoe o10 Ae 'M e"' 4I q"a a Oaf aft -Ile_ Spay
_ a
Reviewer/Inspector Name
Reviewer/Inspector Signature: ate: �. �
0510.310I Condnued
0e)10 916 l W — 900 Z�

Facility Number: 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 am• dead animals not disposed of properly within 24 hours?
28. Is them any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
roads, buildin_ structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
W. NVere 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 submersed fill pipe or a permanent/temporary cover?
Additional
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
(✓e, Cv4stG avas .6e,`.� ��r�y�.l a: Re Al, A A, a-,:,oe
C/a�'itstg�. d,'An4• 4� S®4fa 6S iS 4--uS lG e';' 71.-Ifeill xxe t'�dd�'i►i��� [
/rl /Il""y 1- As 01 � /ltAdc° Ae -
Ill llmze wa s ah e / w aP&C- /*t 4's �e"e a wet-'O- e'w� 1ravC 41 74,-7
djG
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05103101

ENVIRONMENTAL CHEMISTS, INC
Sample Collection and Chain of Customs
NICDENR: DWQ Certificate 094, DLS Certifkate 1037729
Anal 'cal & Co tilting C emists
Client: 1 �iC ;0'xC-'S
Collected B : L
6602 Windmill Way
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Emitil:[e-mail]
Report No:
Sam le x e::l = lntjr:ent
h M hittuent w =welt
Si -Stream Su =boih bu= Siuu a utner:
Sample Identification
Collectiona
9t
of `o
i t�
`a
u "
o
A
PRESERVATION
ANALYSIS REOVESTED
x
z
v
DATE
TIME
TEMP
2 Fe rondik
' 1
C
G
P
lizopw",
r^
C
P
✓
C
G
P
G
C
G
P
G
C
G
P
G
C
G
P
G
C
G
P
G
C
G
P
G
C
P
_
NOTICE - DECHLORINATION : Samples for Ammonia, TKN, Cyanide, Phenol, and Bacteria must be dechlorinnted
0.2 ppm or less in the field at the time of collection. See reverse side for instructions.
Transfer
Relinquished By:
Date/Time
Received By:
Date/Time
1.
2.
�,
v
Temperature when Received: uyp6 c Accepted: ✓ _ Reji rted: Resomple Request d:
Delivered By: fen — Received B . . _ ] ' .—c%Q Date: y c,3 Time: `
Comments. 31 - /(d 6- ---13,2JI 1 - — f►n- - - - -

pky� Environmental Chemists, Inc.
�} 6602 Windmill Way • Wilmington, North Carolina 28405
R [phone] (Lab) • [phone] (Fax)
�►? [e-mail]
ANALYTICAL & CONSULTING` � _
CHEMISTS "'"rNCDENR: DWQ CERTIFICATE #94, DLS CERTIFICATE #37729
Customer:
NCDENR-DWQ
127 N. Cardinal Drive Ext.
Wilmington, NC 28405
Attn: Gale Stenberg
Date Sampled:
Sampled By:
WATER:
REPORT OF ANALYSIS
04/04/03
Gale Stenberg
Date of Report: April 8, 2003
Purchase Order #:
Report Number: 3-1900
Report To: Gale Stenberg
Sample ID
Lab ID
Fecal Coliform,
colonies/100 mL
F1— Field Ditch
# 4490
11,000 est.
2 — Field Ponding
# 4491
300,000
4 — Field/Upstream
# 4492
4700
comments:
Reviewed b:

Orenvir(
ENVIRONMENTAL CHEMISTS, INC
Sample Collection and Chain of Custodx
NCDENR: DWQ Certificate #94, US Certiflexte #37729
1Hn1111P. Iwi1P,! 1 = Infinent_ H; = H'.ttlnent_ W = Well_ N'1' =%trPnm_ XI1 =\nil_ X1 = XlnrluQ i Ither!
6602 Windmill Way
Wilmington, NC 28405
Phone: [phone]
Fax: [phone]
Email: EchemW aoixgui
Report No: 3— IC,(Qr)_
Sample Identification
Collection
� �
� �
a e
� c�
Q o
V
.� �
u
A w
PRESERVATION
ANALYSIS AEQUESTED
c
C
p
DATE
TIME
TEMP
rl
2,
c
P
V,
i-<
2 ! i4 �Dn�Ek
C
P
4qqf
�1
4 UPy}',le(AA'
�^
C '
P
q"Q
C
P
G
G
Ci
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
C
P
G
G
NOTICE -- DECHLORINATION : Samples for Ammonia, TKN, Cyanide, Phenol, and Bacteria must be dechlorinated
4.2 ppm or less in the field at the time of collection. SCe reverse side for instructions.
Transfer
Relinquished By:
Date/Time
Received By:
Date/Time
2.
w
Temperature when Received: [i VC Accepted: ✓; Reje ted: Resample Request d:
-Delivered By: �en�� Received 13 . � Date: y o3 Time: ` S
Comments: 31 Q Pr ✓i5� e, rm '� 2 --

MUORTANT NOTICE
North Carolina Division of Water Quality (NCDWQ) is strictly enforcing EPA regulations for sample collection and
preservation. -- --
Client Must Provide the Following Information
1. SAMPLE IDENTIFICATION (Container Associated with requested testing)
2. SAMPLE TYPE (Composite, Grab, Water, Soil, etc.)
y
3. DATE COLLECTED
4. TIME COLLECTED
5. SAMPLE COLLECTOR
6. PRESERVATION (Including Temperature and pH)
Temperature: Samples MUST be refrigerated or received on ice between 2 and 6 O C. Samples received
within two (2) hours of collection must show a downward trend. Therefore, please record temperature at
collection in space provided on collection sheet_
pH: A two (2) hour limit to chernically preserve samples by pH_adjuustment is allowed, except for metals
samples reported to the Groundwater Section which must be acidified at the time of collection.
Caution
These sample bottles may contain small amounts of acid or other corrosive and potentially harmful
chemicals. Laboratories are required to add these chemicals for certain analyses in order to comply
with EPA preservation requirements. Use extreme care when opening and handling the bottles. If
any chemical should get on your skin or clothes flush liberally with water and seek medical attention.
' DECHLORINATION INSTRUCTIONS
CAUTION: DO NOT Mix thiosulfate with acid in bottle before collecting samples as a
violent reaction will occur.
Dechlorinating Samples that Require Acid Preservation
1. Acid 4-5 granules of thiosulfate to a bottle with no acid preservative (unpreserved BODfMS bottle).
2. After mixing to dissolve the thiosu lfate, pour half of the sample into a bottle containing acid as a
preservative (Ammonia/TW.
3. Then completely fill both bottles,with fresh sainple.
The Laboratory will verify and document the above requested information.
ref NCAC 2H.0805 (a} o M.
"At any time a laboratory receives samples which do not meet sample collection, holding time, or preservation
requirements, the laboratory must notify the sample collector or client and secure another sample if possible. If another
sample cannot be secured, the original sample may be analyzed, but the results reported must be qualified with the nature
of the infmction(s). And the laboratory must notify the State Laboratory about the iiufractiosu(s). The notification must
include a statement indicating corrective actions taken to prevent the problem for future samples.
ref. NCAC 2ROS05 (a) ('lliM."

Type of Visit & Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit (3-Routine O Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Facility Number slate of Visit: Time: 1=
rQ Not Operational 0 Below Threshold
V Permitted ®-Certified [3 Conditionally Certified
ed C3 Registered Date Last Operated or Above Threshold:
Farm Name: CJ�I� ce. e4 1✓1 SP9 1 Qom z` County: �i t.Gi�.� 1It
_
Owner Name:
Mailing Address:
Phone No:
Facilitv Contact: Title: me"
No:
Onsite Representative: C2Cr _ _ Integrator: I�1fl"q(/
Certified Operator: Operator Certification Number:
Location of Farm:
[]Swine [:]Poultry ❑ Cattle ❑ Horse Latitude ' 0• u Longitude 0' �•
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes WNo
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)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Z -7 *_/ �'_—Z
Freeboard (inches): 15_1< 35--
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E,NO
❑ Yes [R No
❑ Yes 'QZNo
Structure 6
Continued

Facilitv Number: 3/ — l
Date of Inspection OMM
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?
S. 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?
❑ Yes ® No
❑ Yes ® No
❑ Yes M No
❑ Yes 54 No
❑ Yes � No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes N No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ®No
12. Crop type fi t,(/, h6t _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Z.No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 9 No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
[&No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
J�SNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
NJ 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
29 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
(I No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
X[No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes F9 No
24. Does facility require a follow-up visit by same agency? ❑ Yes [�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes R1 No
112 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Comments{refer #o quesd6n i) Expiatn:a y 1'ES snsr�er `andlot-any recaeumentdations:i�r any a_ther com_m_ nts:
_
Use drawings of faeilrtv to better a plsin situations: (use i ddit,nalpessa❑Field Conv El Final Notes
mw e
r31-l" or- Giz i"' dPr7r y�A�� s �e
Reviewer/Inspector Name _"
Reviewer/Inspector Signature: Date:
05103101 0 Continued

0.
Facility lumber: I Date of Inspection �z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes �INo
liquid level of lagoon or storage pond with no agitation? V
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 59,:No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [.No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes R No
32. Do the flush tanks lack a submerged fill pipe or a penr=entltemporary cover? ❑ Yes XLNo
Additional Comments and/or Drawings:--. _
05103101 1

j(Division of Water Quality -
0 Division of Soil and Water Conservation; .
0:Other Agency.. .
m
Type of Visit 72Tompliance 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 j Date of Visit:
© Permitted [3 Certified Q Conditionally Certified 13 Registered
Farm Name �e (� ^ f�� e S G' S i-nc , r t✓ti 2—
..................... 1...................... ...1...............
OwnerName: ......... tfGS............................................ ...........— .............
Facility Contact:
.. Title:.......
i d [ Time: l j Printed on: 7/21/2000
Not Operational 0 Below Threshold
Date Last Operated or Above Threshold- .........................
1p,
County:. . . f..I..L.`..:?:............................ ......................
PhoneNo:.......................................................................................
Phone No:
MailingAddress: ..................... . ...............................................................................................................................^.:...........................r..................... ..........................
Onsite Representative: ... &' v;# G !! ... klj.)..1�l.... ......................... Integrator:.' l Ur .! .... ' f................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1i 66 Longitude 0 4 46
Design Current,' Design Current Design Current
r..
5wiue :-. Ca eii Po elation' Poultry' Capacity Po elation Cattle lion
Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish f J� ❑Non -Layer ❑Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity.
Gilts
Boars Total SSLW
Number of Lagoons - t ❑ Subsurface Drains Present ❑ Lag^on Area 10 Spray Field Area
Holdiix onds I Solid Traps ❑ No Liquid Waste Management System
Discharses & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field [IOther
a. If discharge is observed, was the conveyance man-made? ❑ Yes W No
h. if discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes f2'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 12No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ;0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O No
Waste Collection & Treatntent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes -0No
Structure I Structure 2 ? rStructure 3 /j Struct re`,4 Structure 5 Structure 6
Identifier: ..............}.........................3.........................'T.'..Csc...1..— Z!laRe.................................................................. •.
Freeboard (inches): 2-i Z D !
5100 Continued on back

Facility Number: Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes A No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes No
(If any of questions 4-6 was answered 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? ❑ Excessive Ponding ❑ PAN /❑ Hydraulic Overload
V 12_ Crop type 13 l ` d r, n0.1, � K7R S 7 V -C- , I I
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: did Ablatidiis;oe deficiencies ere pofed. during this;visit: - Y;oti'mill•;ebOW iio further. ;
. - . - correspondence: ab6u' f this visit:
ntnents (refer to question #): Explain any YES answers and/or ar y recom�nendatiains or any other: connments
drawings of facility i6 better explain;situations (use additional pal1ges as necessary)
❑ Yes ONO
❑ Yes X1 No
❑ Yes ff No
❑ Yes ,SNo
❑ Yes ONO
❑ Yes 9No
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ONO
❑ Yes Pf No
❑ Yes ONO
❑ Yes WNO
❑ Yes -V No
❑ Yes JA No
❑ Yes fj'No
❑ Yes J�fNo
❑ Yes No
[]Yes No
❑ Yes J4 No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5100

Facility Number: Date of I uspection 3 R O Printed on: 7/21 /2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'VNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes PNo
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 O No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IfIg No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings:
a
5100

Obiosion:of Water Quality-. _.
Q Division of Soil and WaterConservation t-
Q Other Agency -
Type of Visit P.Compiiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O� Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: % I 01D Time: Z ' 0 Printed on: 7/21/2000
Q A of Operational Q Below Threshold
Permitted 13 Certified [3 Conditionally Certified © Registered Date Last Operat Above Threshold: ............. .
Farm Name. . • ......... )Or
.. 11�r.:`,................ ...
...... ..........
............ .................... �.n........ �.......................................... County %�.
Owner Name:.........(U.WX.500
... Phone No:.......................................................................................
.Facility Contact:` .. Title Phone No .............
Mailing Address:....................................................�........ ....
Onsite Representative:.....�,,,,,,,,,,,,,,,
Certified Operator:
Location of Farm:
............................................................................ ..........................
Integrator: ..............t/ ........................................................
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �` �" Longitude • ��«
=
Design Current
Design Correa# Design .. -- - urrent
� = Capacity Po elation
Poultry
Capacity Population Cattle. .. Ca.=,ci 'Po--Wation
Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
I I 0 f
❑Non -Layer
Non -Dairy
Farrow to Wean
Fatrow to Feeder
❑ Other
-
Farrow to Finish
Total Design- Capacity
Gilts
_ =
`y
Boars
Total SSLW
Number of:Legoons : .�
Soldi g Ponds / Solid TrAps
Subsurface Drains Present II© Lagoon Area
No Liquid Waste
Discharges & Stream Im ikaccts
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/thin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Spray Field Area
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:. �l�.. "Of..... T..li .... ..� ..... .............................
Freeboard (inches): r iff
5100 Lq.t l
❑ Yes [XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes o
❑ Yes VNo
Structure b
Continued on back

Facility` Number: Date of Ir�spectinn 00 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures trees, severe erosion, ❑ Yes ANo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes No
(If any of questions 4-6 was answered 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 maintenancelimprovement?
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? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type P . C] V�_ Is
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
3: �'VQ violations :or delciehdo_s were no(ed• d46 iii fhis:visit: - Yoir wiil •reeeiye 1i6 further - : - : •,
- . - cor'res oridence: a�otit: this visit: • � � � � � � � � � � � . . . . . . . . . . . . . . . . . . .
........................... .
3se drawuigs of facih to.better eat lam situations use additional a recommendations or;auy other comma
omments (refer to question #):. Explain any YES answers and/or any
�AA _
ity. p ( p gas as n ecessary)
Z4 f Uv / r� la
c �m
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes o
El
❑ Yes ENo
❑ Yes P�No
❑ Yes 5q No
❑ Yes Wo
❑ Yes o
❑ Yes No
❑ Yes X No
❑ Yes
ElYes�No
No
❑ Yes KNo
❑ Yes 14NO
❑ Yes *0
❑ Yes ONO
❑ Yes No
❑ Yes No
14� . C_� I_L�
46
CVgA-,-+- s -G1,,
Reviewer/Iespector Name -
Reviewer/Inspector Signature:
&,,_-ka �a.7� W C 0-- " C-1-7 h ow/y
y�
�� 1) , I .` Z, Date: I 1 1 -7 1

IU5':
` Faciihy Number: — Date of Inspection S Q 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 gYor Flow ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes O(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes CTNo
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 XNo
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 allo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P9 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
Additional Comments and/or ravvings:
5100

Facility Number Date of Iiispectiori
Time of Inspection ®24 hr. (hh:mm)
E Permitted p Certified 0 Conditionally Certified p Registered p of Operational Date Last Operated:
Farm Marne: Ilcl1.EnteCpt:ism.Ins..F.au:pu.#.2-4............................................................ County: Duplin WiRO
Owner Name : ................................................... Dell. E:nfeirprises. Inc ........... .................. Phone No: 29fi-.Q6M......................................................
FacilityContact: ...............................................................................Title:................................................I........I..... Phone No:....................................................
Mailing Address: I'OM01.14S...............................•--•-......................................................... Ykazansviile— C................................................... 28149 ..............
Onsite Representative: ........................................................................................................... Iirtegrator:Muephy..F.amily.Farms.... ..................................
Certified Operator: Kcu=th.I'............................ Rell ..................................................... Operator Certification Number: 12166.............................
Location of Farm:
Latitude Longitude �• �' �"
- esign - urrent
Swine Capacity Population
❑ Wean to Feeder
® Feeaer to Finish
p Farrow to can
❑ Farrow to Feeder
p Farrow to Finish
p Gilts
❑ Boars
Number of Lagoons
Holdmg°Ponds I Solid1raps
& Stream Impacts
-Design Current - _Design urrent-
Poult - Cattle
ry _Capacity -Population.. r-�. w Capacity Population.__
❑ Layer
❑ Non -Layer _MIUM
_
p Other
Total Desigii Capacity ' 11,016
Total SSLW- 1,487,160
® Subsurface rams resent ® agaon rea ® SPray Field Ama
❑ o Liquid Waste Management System T
1. Is any discharge observed from any part of the operation? jj Yes No
Discharge originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes p No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ 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 Coilection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway []Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. RU .............. ...13 U ................ ......................................................................................................................................................
Freeboard (inches):...............14..............................22..............................21................................................... ..............
..................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes p No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31-165 Date of Inspection
. 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes []No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? p Yes p 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? p Yes p No
Waste Apolication
10. Are there any buffers that need maintenance/improvement? p Yes p No
11. Is there evidence of over application? ❑ Excessive Ponding p PAN []Yes []No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
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?
CY : N.0:vit A4ons:Ol: -d' di i=ncies:were •noted •during: tlli5 visit.: You. will _receive no. further.::: :
• 6r;r iii"ideki Aou# this '.visit.' : : : :
urricane
ping is underway in cow pasture by furtherest hog houses. Ground is very wet.
Iland-DL.Q): Good grass cover on lagoon dike walls. No problems observed.
❑ Yes []No
p Yes p No
[]Yes p No
p Yes p No
❑ Yes []No
p Yes []No
p Yes p No
[]Yes []No
❑ Yes []No
❑ Yes []No
❑ Yes p No
❑ Yes []No
p Yes p No
p Yes []No
p Yes p No
ReviewerAns ector Name
P Stonewall Mathis Tim,Holland (DLQja T
Reviewer/Inspector Signature: Date:

10 Routine p Uomplamt p rollow-up of VWQ inspection p rollow-up of liawu review 0 utner
Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
Permitted p Certified E Conditionally Certified p Registered in Not Operational I Date Last Operated:
Farm Name: ReHEnterprises,1nu_.F&rmA2-A........................................................... County: Duplin WiRO
Owner Name: ................................................... BeII.Ealexprises.Inc............................. Phone No: 296-.0683....................................................................
Facility Contact:...............................................................................Title:............. ............... Phone No:
.......................................................................................
Mailing Address: PQ.Aux.I.45............................................................................................ Kenaafsville..NC................................................... 28.149 ..............
Onsite Representative: .......................................................................................................... Integrator: Mu.rpky..Fa:Wady.Eacrns.......................
...............
Certified Operator:KenntStk.P........................... BRA ..................................................... Operator Certification Number: 1.7.166.............................
Location of Farm:
Latitude • ' �" Longitude • 6
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? la Yes p No
Discharge originated at: p Lagoon p Spray Field p 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?
p Yes p No
p Yes p No
p Yes p No
p Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 0 Yes p No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway p Yes p No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: RU.............. ............. B.LA .............
Freeboard(inches): ...............14..............................22..............................21.........................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, [3 Yes (3 No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31—i65 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
p Yes
p 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?
p Yes
p No
8. Does any past of the waste management system other than waste structures require maintenance/improvement?
p Yes
p No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
p Yes
p No
Waste Application
10. Are there any buffers that need maintenance/improvcment?
p Yes
p No
11. Is there evidence of over application? p Excessive Ponding p PAN
p Yes
p No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
p Yes
13 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
p No
b) Does the facility need a wettable acre determination?
p Yes
p No
c) This facility is pended for a wettable acre determination?
p Yes
p No
15. Does the receiving crop need improvement?
p Yes
p No
16. Is there a lack of adequate waste application equipment?
p Yes
p No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
p Yes
p No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
p Yes
p No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
p Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
p No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
p Yes
p No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
p No
24.
Does facility require a follow-up visit by same agency?
p Yes
p No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
p Yes
p No
jq..
' X43.viofati0ns'or. deficiencies:were-noted _during. t" visit. • Yair will -receive na furthe' r
• .ckr6e 66deki Abirf this:visit; ....:..............:....::.. ::::: :

Division of Sail and Water Conservation =Operation:Review 77
(] Division of Soil and Water Conservation Compliance Inspection
x 1Quality Compliance Inspection
ff.D
ivision of Water
Other Agency .Operation Review-,
JWRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other �
Facility Number Date of Inspection q�{
Time of Inspection 24 hr. (hh:mm)
Permitted [3 Certified [3 Conditionally Certified © Registered 113 Not O eratianal Date Last Operated .
vd.�
Farm Name: .... ....� ...`.� ---•.;)-q ............... County:.. ... '
..�t'1
................ .............
Owner Name: ................................
Facility Contact: ..............
Phone No:..... .....................
.-...... Title: ....... .......................... ......................... Phone No:
MailingAddress: ..........................................................................,...................................................
..... .....,. ............
Onsite Representative. ....!� e Integrator: ,,,. "� ,,,,,,,,,,,,,,,,,,,,,,,,,
.............. ....................................................................
Certified Operator: ...................................................
Localioa of Faum: t
a
....... Operator Certification Number:....
Latitude Longitude • �� �'�
Design Current Design Current - Design Current _
Swine Capacity Population-" Poultry Capacity _Population : Cattle Capacity Population ,;
F
❑ Wean to Feeder
Feeder to Finish
a
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
lumber<of Lagoons ❑ Subsurface Drains Present I ❑ Lagoon Area JE1 Spray Field Area
Holding_Ponds / Solid'Traps ;" ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes D(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 N'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequaie? ❑ Spillway ❑ Yes ONO
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 413
/4a--
Freeboard(inches): ............ {.�-. .. .............. 1............ .......................... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
3/23/99 Continued on back

r Facility Number: ^) — 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 Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type } �(,�� f
s differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?differr wi-th� 13. Do the receiving cropthose designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?-
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17..Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: N6- iolafigris:or• deficiencies were itgfed ftditg �his:visit: • Y:oil ;w1ll•ree6ve fio further
corresporicience_ Aotrt this visit.
meints (refer;io' gnesfion #} ,Explain any YFS answers and/or -any recommendations or any other continent?
_. _
lrawings of facility t6-better explain s�tuatioias (use additional�pages as nec�ssaiy)
,.
1)
91
❑ Yes KNo
Yes ❑ No
❑ Yes 9No
r
❑ Yes CKINo
❑ Yes JZ No
❑ Yes 04 No
❑ Yes g No
❑ Yes 91No
5(Yes ❑ No
❑ Yes EfNo
❑ Yes O No
❑ Yes Wo
[]Yes WNo
VYes El No
9Yes ❑ No
❑ Yes XNo
❑ Yes N No
❑ Yes fZNo
❑ Yes [�(No
❑ Yes PdNo
❑ Yes D(No
a<
Reviewer/Inspector Name r 0=
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: — Date of inspection ,
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below eyes ❑ 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 AtNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes E�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 K] No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNo
31 _ Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0,No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? M Yes ❑ No
Additional,Comments
an oir
rawigp: _ ' ,` -
y
3/23/99

o t.umpiaint o run0w-up uL LJWV mspecUun o
I Facility Number I
E Permitted p Certified 0 Conditionally Certified p Registered
Farm Name: Bell.EnLer rises kLc_.F.arm.#2:A..............
Owner Name:
Facility Contact:
-up or Uawc, review 0 urner �
Date of Inspection
Time of Inspection ®24 hr. (hh:mm)
In of Opera Bona Date Last Operated:
..--,,,,, County: Duplin WiRO
11e11.Enterpxises.Inc............................. Phone No:29fk-JO683 ...................................................................
Title:
Phone No:
MailingAddress: P.O.Box.145 ............................................................................................ Kenans.ville..N.0 ................................................... 28a49 ..............
Onsite Representative:.......................................................................................................... Integrator: J.!'luxphy..>»amj1y.EAr=.....................................
Certified Operator:Keunetbi.P. .......................... Bell ..................................................... Operator Certification Number: 12166.............................
Location of Farm:
Latitude =0 6 " Longitude a I 0"
urrent_ esign urgent esign urgent
resign
Swine _ Capacity ,
_ -: -
Population Ponit ;Ca aci Cattle W Ca Yaci Po ulation_
T ry p .. ty Population p_
p Layer
0 airy
p Non -Layer
p on- auy -
Other
T©fal Design Capacity:-� 11,016
-;
Total SSLW 1,487,160
Number of:La oons m
� EM, ® u
sur ace rams Present® agoon rea ® pray �e rea �=
Holding Ponds/ Solid Traps
❑ o
LiquidWaste Management System
p can to Feeder
® Feeder to mis
p arrow to can
p arrow to Feeder
p Farrow to Fm�s
p Gilts
p Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? p Yes p No
Discharge originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? p Yes p No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [3 Yes p 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) p Yes p No
2. Is there evidence of past discharge from any part of the operation? p Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? 0 Yes p No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway p Yes p No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. 13.1..3.............. ............. RU ............................................................................................................................................................
Freeboard (inches): ...............IA............... .............. .22............... ............... 21................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
3/23/99 seepage, etc.)
p Yes p No
Continued on back

Facility Number: 31_165 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? 13 Yes p 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? p Yes p No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? p Yes p No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? p Yes p No
Waste Application
10. Are there any buffers that need maintenance/improvement? p Yes p No
11. Is there evidence of over application? p Excessive Ponding (3 PAN p Yes 13 No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Q ' 1V.a •viotations' or. defi-c eirdes •were -nnted'dnring. this visit. ' Yclu' will xereive na further
. • . • t4 fr6pa6deiue: aVoit# #his.visit.................................. .
p Yes p No
p Yes p No
n Yes p No
p Yes p No
p Yes p No
n Yes p No
p Yes p No
p Yes p No
p Yes 13 No
p Yes ❑ No
p Yes p No
p Yes p No
13 Yes p No
p Yes p No
p Yes p No

Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment SIiding?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report
5"� !3 (c,
_36V ZZ Y Pc&1-11//, A'C zlr �j �
9 Z$ —01 9 Names of Inspectors �17141W Z „
a /%4erS
l Freeboard, Feet
3 t L Top Width, Feet
Yes _ x No
Seepage? Yes No
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
/( frees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Yes No
Ia
Downstream Slope, xH: IV ?j
Yes _ No If Yes, Depth of Overtopping, Feet
Yes No
Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes _ CX No

Lagoon Dire Inspection Report
a 2-
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address z9u!d j:Z
and Telephone Number r
7C 3
Date of Inspection Names of inspectors _
Structural Height, Feet Freeboard, Feet 2
Lagoon Surface Area, Acres l Top Width, Feet /D
Upstream S1ope,xH:IV Z� _� Downstream SIope, xH:1V
Embankment Sliding? Yes X No
(Check One, Describe if Yes)
Seepage? Yes No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? -Yes. No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

-/�
Lagoon Dike Inspection Report
�1 2D2312-02S.
Name ofFarm/Facility /}' wfj 228
Location of Farm/Facility 5-x /3
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
1 ,7
Names of Inspectors
Freeboard, Feet Z ((3) Zo " 150 - r[
Lagoon Surface Area, Acres _ �j t e-- - Top Width, Feet _ fG
Upstream SIope,xH:IV ,= Downstream Slope, xH:1V j
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
1__k�rees)
Yes X No
Yes No
Ye s No
Did Dike Overtop? Yes x No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments

Lagoon Dike Inspection Report
Name of Farm/Facility / A '
Location of FamdFacility
Owner's Name, Address j_tl�x li.�S -
and Telephone Number
Lc r s
Date of Inspection Names of Inspectors _i [xl%�(
Structural Height, Feet Freeboard, Feet Z
Lagoon Surface Area, Acres / Top Width, Feet lD
Upstream Slope,xH: I V 2 Downstream Slope, xH:I V_ 3: f
Embankment Sliding? Yes_ No
(Check One, Describe if Yes)
Seepage? -Yes No
(Check One, Describe if Yes)
Erosion? Yes No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes ` No
Engineering Study Needed? Yes %� No
Is Dam Jurisdictional to the Dam Safety Law of 1967? -Yes. No
Other Comments

Division of Soil and Water Conservation ❑ Other Agency
fi
.E
`� Division of Water Quality k
H
10 Routine . -O Complaint O Follow-u of D1V ins ection O Follow-up of DSWC review O Other
Date of Inspection ? $
Facility Number i Time of Inspection 24 hr. (hh:mm)
© Registered 0 Certified 13 Applied for Permit C1 Permitted 10 Not Operational Date Last Operated: -
Farm Name: ��....I!btiS�.S 1:.....r»�....... County:......��!+.!1...............................................................
Owner Name:....... ....:..lct!'.tCi..r.................................... Phone No: ..OiAhgL::Q.&................................................
Facility Contact:........
` ?X .k. . Phone No: ...............................
��`[k 11 Title:............................................................... ..........................................................
MailingAddress:...... .................................................. ............... I............ ..... ........................................ _4Zn3 l....----
Onsite Representative: ..... ��'.A ..... .... ........... Integrator:-_.A4 .........
Certified Operator:................................................................................... ... Operator Certification Number,------.................
Location of Farm:
n....tt ....5' .,..p....... ++z i 3 G o..........:.:?. .... �'.'iis(:......... a ...a....... . r.....:.......:........ .............. ..... .......................................................... I&
............................................... ....... .....
Latitude �• 0` Os� Longitude �• �� 0"
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 oriainated.at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? N 4
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes M 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 IlNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P No
7/25/97
Continued on back

Facility Number: 31 —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures Ll ag_oons.Iiolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z 3 'r
....................................................`t...... ................. ........................... ............................ I.............. ...................................
Freeboard(fit): �:.- ........................... .:................. .........2:e.................. .................................... ......................... ..... ..........................................
10. Is seepage observed from any of the structures? ❑ Yes 9 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..........6_Sr.MUj5 ............................ ... �;N1h.......................... .... ......... ........ ..........................................................
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.were-noted-during this.visit.-:You4ill receive no further
' correspondence about this:visit:::. ::
❑ Yes QPNo
5B Yes ❑ No
❑ Yes ® No
❑ Yes 0 No
......................................
❑ Yes No
❑ Yes No
® Yes ❑ No
❑ Yes phi No
❑ Yes 91 No
❑ Yes Pq No
M Yes ❑ No
❑ Yes 124 No
❑ Yes ❑ No
❑ Yes 0 No
Continents (refer.to question #): Explain any YES answers and/or any recoinmendattons or any other comments
Use drawings of facility tq hetter eiplain setudtinns."(use additional pages'as iTecessarv)l
5. Wasin s�roj oxvA d r,.j&. lair. &Jl :s W(fV_1111 Wil�_ Di*iclf Salt 1{ (njw r 65r
Gojk c-ild
12 , &, sio o v o s or- o ukfx a C (u Wtik l d 6)aor` 3 ► v Kw d i v ra- l l o-F *L-. T ,e Gas-,6,)1i j 6.Q
lv1v 1,
u1 tt/Pl�tT�7 u� ,
ttj Ll.t1 ►J i `Y _ cj" + rt s Gd d • tic Vt awwS a t. a I t �lrtf# 1Dklatr, d j V- "i�-3 54 N dQ
o� ���►� # t� toad) he ftvw-ed.
}}
zz. (�. WA d� tTr % 6- G �l e gkoLA he. in �i �ied }� O, 5p 1 mcorj% 5kovfd
4f U Z"r `i�.��
�7/25197
f% e[S.PLTY\s
b1yfull ZaA.0 norn9xr e,\LJ04� _ �e� GCGt-ccs� e �i r�i#Y Qt- ��o.rc
b113 . ,4Y'4 C l VC lk� d LtT !1� J3—S-M ehf 1OZ• far Ca 4 COG .
Reviewer/Inspector Name, r
Reviewer/inspector Signature:Date. gaQ

❑DSWC Animal Feedlot Operation Reviewer _ -
'
W.
�DWQ Anlmal Feedlot OperatlonPSi Inspectlon
®-Routine 0 Cum laint O Follow-up of DWQ inspection Q Follow-u of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: El Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
19 Certified ❑ Permitted I or Inspection includes travel and processing)
❑ Not Operational Date Last Operated: .. ... _.. ._.
Farm Name:
County:}��s �........._...
��.j�..�.��.�..�:�..L-.�..3....�.�.�.�.�t�x.: �..�.,�,�.�s.>.�+... ......_.....�.1
Land Owner Name; ...f-c—i... ud.......... Phone No: .
Facility Contact:... _......_ ............................. .. Title: _ Phone No: ... C..S.Lq.1.{ e
C
Mailing Address: P.. fit... .ss _ 1..�_....._....__.. _._.. _ .. �, �1�.i1�.�e7..ham ...._ ... z 1.1
OnsiteRepresentative:. ..... Integrator: !�1i.:L.�.
Certified Operator: ...K,,t&c AC ........ ............... ........ .......... _.......... Operator Certification Num er........,...7
Location of Farm:
..��,_.ac,?.�.5�.�......S.:s.d..�...c. �4.. ._a.�.�.�...�.� , c�.:..�.5.-...►�ara.�---Q..L...s�.t.Lka....�.:......l.f► --•• -.._. 4
Latitude ©•laic 44 Longitude '7% �4 ©6.
Type of Operation and Design Capacity
r nrr- n
Design CtirrenE DesigaCaTrent Des�gny Current
Swine ' ?Ca ` ki = Po elation �Puuliry. _: Ca aci Pa 'alatton ��aC$ le Ca ace Pii elation
❑Wean to Feeder ❑ La ❑ Dairy
10 Feeder to Finish Z °�❑ Non -Layer Y ❑ Non -Dairy
Farrow to Wean �.
., w
Farrow to Feeder Total Desg Capacity G� �-� tt
Farrow to Finish
�A M LW ❑ Other;
Number of>Lagaans! Holding>Pogds ❑ Subsurface Drains Present
?s ME—
IN �F
`� vk'e -r Lagoon Area ❑Spray Field Area
eneral
I. Are there any buffers that need maintenance/improvement? ❑ Yes IffNo
2. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes (9 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ®.No
c. If discharge is observed, what is the estimated flow in gal/min? iJ 1 A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ES 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 J.No
4/30/97 maintenancelimprovement? Continued on back

Facility Number:...._
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
®No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Struclures (Lagoons and/or Holding Ponds
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
E-No
Freeboard (fI): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
Q 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-I2 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 �a l�r ^a �tsl tJ<.. _ ��1.� i ................ .......... — .,
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
29 No
18.
Does the receiving crop need improvement?
❑ Yes
M 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
BNo
For Certified Facilities On y
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
24.
Does record keeping need improvement?
R Yes
❑ No
immentsr(refer 'to'auestinn #1_ Ezolainsanv YES -answer's and/or `anv recommendatioit's'b `a
2q • G e,{ 5-0 1 1 S a_ p 1 �-S &1L
py, jrYti 3a- awk lY'eC_40V4j,
CI e—t. Vv, o- J {�i�..�..
Is
1 4
} 4 a kZ- S u 'r e. t f v+ v w, 6A,,5 o- 1 1 S ¢-e.-k
e- VlCl Z- k v��7 0 y4 0. I
Reviewer/Inspector Name
Reviewer/Inspector Signature: 1 Date: j
w. Division of Water Oualitv. Water Oualitv Section. Facility Assessment Yj.it 4/30197

®-Routine O Cam faint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 1 0 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered [I Applied for Permit (ex:1.25 for I. hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated:......W.... ___...__........................ .......... ......... ......... ........ __.... _...._ ......... _...._........
Farm Name:.. ...,..,r i.�,.....�....►z-a_ Couuty:.�,.�.t.rL _ ..........._�..., �t-
Land Owner name:.. i (..�.� '^ �+' p.x a.j.......................... Phone No:
Facility Contact: .... ....... ...... _ ...... ...._...... ......... ....... .............. Title: Phone No: ..� °).1_�.�._ ..Q.024
Mailing Address: )...
_&41S... �.. ...... ....., ....__.... ..... _....._ ........_%-3.nct . S �1.3. ..1�, .,� r ..... .S.` .
Onsite Representative:.... �...�x.:.�..c.��.....rr�..�.�.........._._........................�. Integrator: _....... k�.ar.__.....
.. .......
.+...........
_....
......
Certified Operator: ....Kex..0 A. _., Operator Certification Number:��
Location of Farm:
� � �i-. j..._.�,.. _ .c�.�c.s. �-g......L1.�.2.-�r._.�sn.a..3.�.5....S.o.s.t. �......�ct...._.............__ i?
......_.&_.t�.
p
.0..Q q....................- .... ..... _....__.........._ .._........_ ....._.__... ....._ _............ ......... _...... _ ......... 45�
Latitude ���� �r� Longitude
Type of Operation and Design Capacity
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes IN No
❑ Yes C$ No
❑ Yes [5 No
❑ Yes ® No
❑ Yes
R No
❑ Yes
® No
❑ Yes
UR No
❑ Yes
tH No
Continued
on hack

Facility Number:...... •—.. 1 .
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (La!oons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ®.No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes RNo
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 � ....... .... .I1..q ix4................... ..........
_....... _.
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?
Fpr Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes Ed No
'0 Yes ❑ No
❑ Yes (Q No
❑ Yes El No
[I Yes ® No
❑ Yes ]@ No
❑ Yes ® No
❑ Yes ® No
❑ Yes 19 No
❑ Yes JR No
❑ Yes I3 No
❑ Yes $1 No
Yes ❑ No
Comments,(refer ta''questioi ° #1), Explainany YES answers and/or any recommendations or any other comments:
se,drawings of facility to better explain sit�uahons; (use additional pages. as necessary) `x H
aev :a c x,:
12- Iv► a w l a-yo o w a t#
Z� Cr G E So 111 t S. a.-
01n 1rr� d�0V% Y'�G6rdS'
5 p e,u.
NA- Y-t- S v r Q k-ytL c- ( v. j ,,, b try a •-e. ), S
4--j- -o `e- � l "F q " T' '.-,cl 4 " a I I
Reviewer/Inspector Name
t
Reviewer/Inspector Signature: �j„ n .Arm �,yn Date: I
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of inspection
Facility Number 3
Time of Inspection 0: y � 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
91 Certified ❑ Permitted Lor Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: .9. L.Ls.. _ fX. ..-. r. ' ...E..Y_�a. � �. Coun0':.. 1.14
Land Owner Name: - ..... Phone No: ..
Facility Conctact:... _....... __...... ._..... ..... _._......_.................... Title: _....._- ... _ Phone
Mailing Address: d p i
Onsite Representative:... .. ..... g i _._...._ ....-----........ Integrator:...�
Certified Operator: .... }... tk. ..... __..... ....... Operator Certification
Location of Farm:
.t2�a....1N!.t<�. ....� .e............5.�).�..�+..Q..}._-�-�-�..r..e.a4..Lrr.!..a.. _ _D.:�S.-...+on.,_1.eY.c.S.aa,.�.._�.....t.,c�..�.......-...4
.............................._...................__....................... .............. ..._.............................. ....................... ........ rY
Latitude 1 35 • 4 ® u Longitude ©• ©� ® µ
Type of Operation and Design Capacity
�.
Design Current Design f �Cu�rent� Design Current
SwineCa aci Po ulitionPoultry „Ca" aeitvPo elationttleyy Ca ace Pao elation
❑ Wean to Feeder ❑ La ❑ Dairy
Feeder to Finish Z "a ❑ Non -Layer JJEINon-Da
Farrow to Wean hME
El Farrow to FeederTt)tal Destgn Capat tty , d 2
r�
Farrow to Fmish �S
.. �. fT�tls Lw s
0 Other
Number of Isgoans 1 Holding Ponds ❑ Subsurface Drains Present _
M u, Lag ea
:::��` ❑ ❑
oan Ar � S Field Area
Spray
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes PS No
❑ Yes 0 No
❑ Yes 18 No
❑ Yes JR No
❑ Yes
JR No
❑ Yes
RNo
❑ Yes
No
❑ Yes
No
Continued
on back

Facility Number:..3..1...-. —..4.q
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 19 No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structiures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
Structure 4
❑ Yes 0 No
❑ Yes gNo
❑ Yes IR No
Structure 5 Structure 6
10. Is seepage observed from any of the structures?
❑ Yes
El No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
P9 No
12. Do any of the structures need maintenance/improvement?
9 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
0 No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
S No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... .......... 5.4:1 &L.isII-r-m-i_W4 ... .....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
e( 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 Iack of available waste application equipment?
❑ Yes
EaNo
20. Does facility require a follow-up visit by same agency?
❑ Yes
ED No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Aninial Waste Management Plan readily available?
❑ Yes
® No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
24. Does record keeping need improvement?
aYes
❑ No
Comments;{refer to`quesUon`#) Explain any, answers and/or aay recommendations'or any other cornrgcn l
Use drawings,of facility to better explain situations (use additional pages as necessary)
.,m r.
tZ. N1o� L°�oi,n
4
is. we.,�Ld
N. Cx4_t s e i 1 s a v. P 1 #4 L-� e +� . M Q ice 4 u r e � t ►� v ,.... b PirS o�..-2
: S �� +(
o
" r r i Q Lt-i t vt r e. c. o �4 S
�TCt a Q....'4"le' PLa,, Gy1 tv r@ 1�ir< - L�V_U
'#� _. i5 a't,".> Al
Reviewer/Inspector Name.
Reviewer/Inspector Signature: ��„ `Ajj 2 Date: , I
�. ........r U
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4130197

1
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
i DATE: '7 `Z , 1995
Time:
Farm Name/Owner: 6�&
Mailing Address:
County: Q �--
Integrator. Phone:
On Site Representative: e 1-� j.CIGS /-a Phone:
Physical Address/Location:
Type of Operation: Swine t/ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:" c Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: 3 Ft. Inches
Was any.seepage observed from the lagoon(s)? Yes 01& Was any erosion observed? Yes of V�i
Is adequate land available for spray? Qpr No Is the cover crop adequate? e� or No
Crop(s) being utilized: Cr, A,L
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or TQo
100 Feet from Wells? Yes or�V]'o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? 'Yes orGI
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orQ
Is animal waste discharged into waters of the state by man-made ditch, flushing system,'or other
similar man-made devices? Yes o 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)? Ye or No
Additional Comments:
Inspector N Signature
cc: Facility Assessment Unit
10
Use Attachments if Needed.

Site'Requires Immediate Attention:
Facility No. t - 49 E
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
.Time -
.Farm Name/Owner: .
Mailing Address:
County: D To b lj
Integrator: )M�'!yhy Phone:
On Site Representative. ��1 �L1 o,S��Y Phone:
Physical Address/Location:
Type of Operation: Swine 1Z Poultry Cattle.
Design Capacity: Number of Animals on Site: 3(... 7 Zo
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ac// Longitude. � ' .�� 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) Yes or No Actual Freeboard:.- Ft_ Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes r No Is the cover crop adequate? (1j '' or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? ( or No
100 Feet from Wells? Yye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or&
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or N)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ocn 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)? es or No
Additional Comments:
6N
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. ��
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: `2 , 1995
Time: k be)
Farm Name/Owner: e
Mailing Address: _ ,f ,5� � d z f�5 v if& ; 3y;- `
County: fly
Integrator: D!Yv4 Phone:
On Site Representative: W611Y
6'0A_.Phone:
Physical Address/Location:
Type of Operation: Swine t/ Poultry Cattle
Design Capacity: Number of Animals on Site: 3 L-7 - 3_
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 5- ° LJ Longitude: ]_�L" 5q ' • u Elevation: Feet
Circle Yes or No
Does the Animal. Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot } 7 inches) es r No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: C b4, � _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? ' se or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or TQo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or@
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orQ 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)? Cr No
Additional Comments:
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.