310197_INSPECTIONS_20171231

NUHTH CAROLINA_
Department of Environmental Qual

(Type of Visit: QICom ce Inspection U Operation Review U Structure Evaluation (� Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of VisitT 112/1 Arrival Time: Departure Time: � County: Region:
Farm Name: Owner Email:
Owner Name:
r
In
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
56i^F"I 90 V,? 7 9.heL
Latitude:
Phone:
Phone:
Integrator•
Certification Number: / J' %J—
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
I
Wet Poultry
ILayer
Design
Capacity
Current
Pop.
Design Current
do
Cattle Capacity Pop.
Dairy Cow
Wpan to Feeder
Non -La er
Da Calf
der to Finish
1 • o o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
2 t.ia
I)r. P,oult .
Layers
Design
Ca aci
Current
Pao P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBeef Brood Cow
Other
El Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
I. 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 ❑,Ne—❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes []�off❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: 7-117 1 jDate of inspection: p r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [;INU-- ❑ 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): 3Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ETNo ❑ 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_�qu ❑ 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
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 E 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 No ❑ 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 ENo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ffNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2 go
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ZrNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[?r�o
❑ NA
❑ NE
the appropriate box.
❑"P ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EfNo ❑ 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 ZrNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑'N-6 ❑ NA ❑ NE
Page 2 of 21412015 Continued

Facility Number: ?I Date of inspection:
2.4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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:
No ❑ NA ❑ NE
0-1 !o ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
[—]Yes
❑ No
Q'FIA
❑ NE
[:]Yes
13'No
❑ NA
❑ NE
❑ Yes ❑ o [:]NA ❑ NE
❑ Yes ❑�Ko_�❑ NA ❑ NE
❑ Yes E],Nn ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑,No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [-No ❑ NA ❑ NE
lle34. Does the facility require a follow-up visit by the same agency? ❑ Yes �lo ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of
(1�2
Date: l /3 r 7
21412015

Reason for Visit: Q'ftoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: EZ*6 Arrival Time: � Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: " o P Z—
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Region:
Certification Number: j 9 9 7 q-
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
We[ Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
an to Feeder
L(p
Non -La er
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
eder m Finish
Farrow[c Wean
sip
9 9 3 t� Design Current
D'Piouliry C8 acity Pi0Ca acity P.o P.
Layers
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
01
I,- e
Other
Turke s
ITurke Poults
Other
Discharges and Stream Impacts
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 �3<0 ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Eet o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 21412015 Continued

Facilily Number: DI jDate of Inspection:
.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21-5o`�E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3&
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes if7--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 TDd�M-
❑ 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
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes � No ❑ NA ❑ NE
maintenance or improvement? �'
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes DINO ❑ 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
E3No
❑ 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
Ej'No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
J[ NNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
j`No
❑ NA
❑ NE
Required
19.
Records & Documents
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ej­No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EjNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

[Facility Number: Date of Inspection:
• 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes QNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Z No
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:
❑NA ❑NE
❑ NA ❑ NE
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 �IA- ❑ NE
Other Issues �
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes r J 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?
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 tiie drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
[:]Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 2No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Date: 7 16X-6
Page 3 of 3 21412015

(Type of Visit: 0 CIotgpHance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: U Routine . 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ti/2y//p Arrival Time: O© Departure Time: /OY O County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: ;OA "K10 j/4 �y�t^PZ
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: I q p o
Certification Number:
Longitude:
Swine
Wean`to Finish
Design
Cacity
pa
Current
Pop.
I
Wet Poulttry
11-ayer
Design
Capacity
I
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
can to Feeder
4 90
1
INon-Layer
I
Dairy Calf
eder to Finish
1009
(0 2
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
3590
O 2
Db P,oult .
Layers
Design
Ca taci_
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113eefBroodCow
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 E�Io ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

I
Eacili umber: 9 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�TNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes [ff No ❑ NA ❑ NE
[—]Yes ffNo ❑ NA ❑ NE
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 Ej�,No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ] No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [!] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [/rNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ff No
❑ Yes [TNo
❑ Yes dNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes Ef No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
]Yes ❑ o ' ❑ NA ❑ NE
❑ Yes ] No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 7[ jNo ❑ 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 eN ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility umber: q jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yesgto ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 the 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 No [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[—]Yes dNo ❑ NA ❑ NE
[:]Yes dNo ❑ NA ❑ NE
❑ Yes 9."
No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Signature: QGYrr" 4� 'j Date: S 2 L S
Page 3 of 3 21412015

Type of Visit: ,Q
Reason for Visit:
Date of Visit: F.
Farm Name:
—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Referral () Emergency O Other
re Time: County: I
Onsite Representative: I C�Ua'7 o 0e Z
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Denied Access
2!l_ Region: ��
Desigu Current
Swine Capacity P.op.
Wean to Finish
Design Curren[
Wet Poultry C+apacity Pop.
[Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , P,oult . C_a act P,o P.
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El 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)?
❑ Yes VrNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes [44No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes V No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑do ❑ NA ❑ NE
of the State other than from a discharge? 7777
Page I of 21412011 Continued

Facility Number: - Date of Inspection: 3
Waste Collection & Treatment
4. Is, ;Aorage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ YesVNo
❑ NA
_
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
/
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?
'0
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
ZNo
❑ 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)
YYYYYY'"
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 F(No ❑ NA ❑ NE
maintenance or improvement? 1
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes I/ I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, eta)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
�No
❑ Yes
[D"No
❑ Yes
F�rNo
❑ Yes ErNo
❑ Yes �TNo
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes E�(No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E 2 No
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faci6 Number: 111
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes VrNo
237is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes [3`No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes�No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes .f!�No ❑ NA ❑ NE
[—]Yes
ZNo
❑ NA
❑ NE
[—]Yes
�— N/o ❑ NA ❑ NE
I ❑ Yes XNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP? ❑ Yespl
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes t No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.. .. ....
I se drawings of facility to better explain situations (use additional pages as necessary).
j�a'/ ✓'1 fe corG�s (a T c �r ec,
�A/iy a, c,3
Izlr3 l3
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Date:
Page 3 of 3 71412011

�- - �161vision of Water Quality =' ,
lll;y Number D Division of Sod and Water Conservat
Type of Visit fd'Eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitle rcoutine O Complaint O Follow up 0 Referral O Emergency Q Other ❑ Denied Access
Date of Visit: 3 Arrival Time: �--/ Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative L 4-/�Qr 7 4 ��
Certified Operator:
Back-up Operator:
Phone No:
Integrator: rn /r
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: L-1 V LA' 0 11
Longitude: 0 0 0 ' =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes GI'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑'No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
EJ No
❑ NA
❑ NE
Pagel of 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes 2_ 1 El NA ❑ NE
a. If yes, is waste level into the structural freeboard? El'LI Yes No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
XNo
❑ 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
P No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
,/No
9. Does any part of the waste management system other than the waste structures require
ElYes
1
ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ETNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gNo
❑ 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 asynecessary)c.. _ ..;
P I� -1
ch?E/'t
Aj
��/d%7/ram cj�6�chclCo✓G/"`
�Gu� 4o�i
IReviewer/Inspector Name Phone: . 7 . Cp— 7 I
Reviewer/Inspector Signature: �/; Date: 3
Page 2 of 3
Cnn/innnd

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ��,,,��N!!!o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L„d No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNO
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J?fNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ YesPK
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ld No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes grNo
❑ 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 E�(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 PNo
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [(No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No
❑ NA ❑ NE
Additional Comments and/or Drawings:
it '201 a ,Sot) sample, was
InIly
7)iod 1�s
`1,2410
° //n /Ccoolohs %oA�
Page 3 of 3 12/28/04

IType of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: ��Iparture Time: County:
Facility Contact: 1 Title:
Onsite Representative:,-� �r� 7aUe—z
Certified Operator: C
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: Lz�
Latitude: = o = ' = Longitude: = o = ,
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultn}' Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer 1
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer 1
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dr}' Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
La
❑ Layers
❑ Non -Layers
El Pullets
El Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
❑ Gilts
❑ Boars
❑ Turkeys
Other
❑ Turkey Poults
Number of SVuctas:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
oNo
❑ NA
❑ NE
❑ Yes PNo ❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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
�ZNo
❑ 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 ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
VNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
�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
ElNA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
gNo
❑ 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
yNo
❑ 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 acre determination ?
❑ Yes
Pf No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or,any.other comments
Use drawings of facility to better explain situations. (use additional,pages as necessary):. -..
Reviewer/Inspector Name Phone: — 4 7,;L 5
Reviewer/Inspector Signature: Date: ,(
Page 2 of 3 1 l2 28/04 Continued

Facility -Number:- Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes XNo
❑ Yes gNo
❑ NA ❑ NE
El NA El NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes Ip No ElNA ❑ NE
ElYes ZNo ❑ NA ❑ NE
El Yes
V No
❑ NA
❑ NE
❑ Yes
PrNo
❑ NA
❑ NE
❑ Yes
LYNo
7WNo
El NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
P(No
❑ NA
❑ NE
❑ Yes
[/No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
01'3No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:' K
_.,f._. ,,..._w._. ..
S
/W704 � 6
�2/3/O q / • 7
Page 3 of 3 12128104

MOM" of Water Quality
rilify umber '3 / - O Division of Soil and Water Gonservallon
Q Other Agency
Type of Visit Oeompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for VisitiQTRoutine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
?''( Time:
Departure Time: County:
VL Region:
Farm Name:
/Arrt''v21
/ /�✓/ TC=t(�—C)Il�% <
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ✓fff'liD C/ Z9l�TL
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=o[=,=" Longitude: =o=, ="
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
J�INo
❑ NA
❑ NE
❑ Yes
R I 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 P'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ErNo ❑ NA ❑ NE
Structyre 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C�17 Z
5.
Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[P"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
9�&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
�JNo
❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ yes
;ZNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require ❑ Yes
[/No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
``
D o
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
�/
IQ 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
O No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
fNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P1,No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ENo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
M4
❑ NA
❑ NE
Comments (refer to question #): Explain aby`YES answers and/or anv recommendattons'or anyfother comments ^ �« <
Use drawings of facility to better explain situations. (use additional pages as necessary) ^"
IReviewer/inspector Name C J l' Phone: 7-C/ �3 i Q I
Reviewer/inspector Signature: Date: " 2 G
Continued

Facifity Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [J'No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �TNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;'i`Io
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E:fNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E!fNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�rNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
21 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
12128/04

.t�ivision of Water Quality
�FaCility Number Division of Soil and Water Conservation
- - O Other Agency
Type of Visit 0-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit )O^Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 0 U Departure Time: County: U 1/t Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Tide:
Onsite Representative:.i- �Igy .;z
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Design Current
Capacity Population
02 Wean to Finish
y00 y�Z�
❑ Wean to Feeder
L�Meeder to Finish/0001
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' =„ Longitude: = o
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
r
yDry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Dischar¢es & 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?
Cattle
y Calf
y Heifej
Cow
MGM
Design Current
Capacity Population
LJ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl 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 [�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
P�1No
❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes CrNo ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑''No ❑ NA ❑ NE
❑ Yes ;rNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes O'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) r 9. Does any part of the waste management system other than the waste structures require ❑ yes toy No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LJ No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 Drill ❑ 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
E No
❑ 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
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P�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):
°'��
�Q/`rt � lS f`rPaf. //ei�r G✓el 7J'I�i•r /r-tat,
// 06
E'wer/Inspector Name
K G Phone: j �G- 6V -7--S91ywer/Inspector
Signature:
Date:
12128104 Continued

r
(Type of Visit aCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit .0'Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,OC/ Departure Time: County: Zvi Region:
Farm Name: "-f.'/'/ 1/L4� f__?;! /N? ___� 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:
Latitude: M o[-�' M Longitude: mom, M
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
113'Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
IEJ Non -Layer I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
ElTarrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Layers
ElNon-Dairy
Beef Stocker
El Farrow to FinishEl
El Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullers
❑ Beef Brood Co
❑ Turke s
Number of Structures:
Other ❑ Turkey Poults
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any partof the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [2'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
El NA
El NE
❑ Yes
El Yes
,.❑No
4!fNo
❑ NA
❑ NE
❑ Yes
,YJ No
❑ NA
❑ NE
12128104 Continued

FacilityNumber: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes . fNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ffjNo ❑ 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.,ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Jallo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes )2-go ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )]'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable �Cropp Window 1 ❑ Evidence of Wind
Drift ❑ A�pp�lica®ti'o/pOutside of Area
12. Crop type(s) ICJL�7///,/iiG1V/1 l 1
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?
❑ YesA�No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes f:rNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes .U/ 1V0
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes �
❑ 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): _
i
Reviewer/Inspector Name I Phone: ' . ` —
Reviewer/Inspector Signature: /[ Date: 4 '5117 1616
0
Peon 7 �f 2 12/2R/Od Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes 3 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes P�No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes E `No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ONo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ,ETNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes -f No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes [—'[No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
O'f4E
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
] No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
.
LI 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
nNo
❑ 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
El -No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
.BNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
'Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance -
Reason for Visit 06outine O Complaint O Follow up O Referral O Emergency 0 Other —/ ❑ Denied Access
Date of Visit: e.3 Arrival Time: Departure Time: County: Nh _ Region:
Farm Name: g��� �/^�yl� Owner Email: P�
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ,� / Title:
Onsite Representative: SGvl li V47 Z _
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
ea
can to Feeder
Feederto Finish
0 Farrow to Wean
a
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife
❑ Dry 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?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑]N` o
El Yes
EI No
❑ NA
❑ NE
❑ Yes X] No ❑ NA ❑ NE
12128104 Continued

Facility Numher.� — Date of Inspection r3 G
M wage Cobection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /❑-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 7 (/
Observed Freeboard (in):
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes _J2 Go
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA
❑ NE
through a waste management or closure plan?
,B`No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7.
Do any of the structures need maintenance or improvement?
❑ Yes j2No
❑ NA
❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes oNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require
❑ Yes PNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes oNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind �Drifl El Application
- Outside of Area
12. Crop type(s) `�Gr/; ZG_, L /=i ) 1 i . <(7
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Jallo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
[:]Yes J:jNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![-] Yes O'No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes �o
El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes , No
❑ NA
❑ NE
Reviewer/Inspector Name G!r//( Cow Gj ' 4,f;{ Phone:
Reviewer/Inspector Signature: Date: % 3

Facility Number: 3 — 7 Date of Inspection Ovb_
ReguireL*Records & Documents
19 Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'Jallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�lNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LJ-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,2No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ,ENo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes E:FNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes �3'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 ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ;2No
❑ 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 Flqo
❑ 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 ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
_J
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes ZI No
[I NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes p1ro
❑ NA
❑ NE
A`dditioua] Comments at dli r Drawings: w, ,1 a .> - A�
-
�-Clfm %S l Vl O bVl (2P CoYC� S
Yl L'cc
d� a rrl.e��1. ,
12128104

Type of Visit CS Co liance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 4Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: � W4 Time: 3
O Not Operational O Below Threshold
Permitted 1C1ertified 0 Conditionally Certified
/13 Registered Date Last Operated or Above Threshold:.___._ _.__..
Farm Name: ....._q °�_.cT�.ize._ 1� 4....Cf...!:"'�':At!__4.f%1�46ii�?A�_�i..L County:..,;, 1%Pr. ......_._........._...._._._ ..__............._.
OwnerName: -------- ----------------------- _---------............................... _............. _........ _............ __... Phone No:
MailingAddress: ......... __._._.................. _.............._.._._......._._............
Facility Contact: .... ........ .................... _._.................._...._......._... Title:
Phone No:
OnsiteRepresentative:._5�1((,jAGO..._vAZQ,�f�'{,........... ............... ... Integrator:..._._..M.� f-R..OL ....... ............ ___ _____
Certified Operator: ... ....... ............ .......... ............... _................. ... _.............. _.... ........... Operator Certification Number:
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude =• =' =" Longitude =• =' ="
Desrgn `'Current `- Desrgn Current = Desrgn Current
Ca
n Pl
nlatton
_-_CseP"u.parity .-Po
NNYean
to Feeder
e(yp
O$
❑Layer
❑Dairy
eeder to Finish
i b O O
16 $9
L
❑Non -Layer
' ❑Non -Dairy
Farrow to Wean
pp
37Zt
❑Other
t ,
Farrow to Feeder
`
Total Design Capacity, ,
Farrow to Finish
G ilts
4 f=s
�'TofaISSLW "
Boars
r_
Number of Lagoons
t.
Discharges & Stream Impacts I
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes ❑ 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 �QN//o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑No
Waste Collection & Treatment /
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Q No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......... ._...
.... _............ ........................ __ ... ................... _.... __.___._._.
Freeboard (inches):
12112103 Continued

Facility Number: ; j — jqj Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
[3 No
closure plan?
(If any of questions 46 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?
�/
lr Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
U�r`Io
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
0No
elevation markings?
Waste
Application
Yes
�/
10.
Are there any buffers that need maintenance/improvement?
❑
N9
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type a[;f *xy:l ( & A) S'GO
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N9
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
;Ng/
b) Does the facility need a wettable acre determination?
❑ Yes
r�fo
c) This facility is pended for a wettable acre determination?
❑Yes
p
15.
Does the receiving crop need improvement?
x 0es
u
❑�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[ No
Odor Issues __!!
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes 0rvo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt ❑ Yes Q,)KO
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Field Copy ❑ Final Notes
L M.UTIA of Fgt3RUAtLY 2w3 WraSSEo WAsW_- ArJA(iSXS. COANG�EA IWOVE11Ci slwk omcs
KEEP t�vY D F GQdP `iSEW w� �"Lo 07-t 1'0oJiDEA tt
15) VIZ4. D 3 4, 2 plEEo wm�o Go�tf6�t_
-7.) 6-c-CS5-rd_ASq XW LACwOorJ
4oM61-3 t.AGaot`I DESK N Forte S"ft-r POAAr LAOEL,
4C." S �atL. R V*.j;0 ' -W Goo SWAIFE
Reviewer/Inspector Name ff
Reviewer/Inspector Signature:
Date:
�m�ciw wswsucu

Facility Number: 3 — ��7 Date of Inspection 2a 0
Required
Records & Documents
/
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ONo
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ s
140
23.
Does record keeping need improvement? If yes, check the appropriate box below.
� Yes
❑ No
❑ Waste Application ❑ Freeboard Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[J/
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
7 No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
NNoo
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Q1<O
28.
Does facility require a follow-up visit by same agency?
❑ Yes
/
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�
p o
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
33.
Did the facility fail to conduct an annual sludge survey?
[I Yes
;<o
34.
Did the facility fail to calibrate waste application equipment?
❑ s
2<0
35.
Does record keeping foFNPDES required forms need improvement? If yes, check the appropriate box below.
p Yes
❑ No
❑ Stocking Form L/1J Crop Yield Form []Rainfall []Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit Z) Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Y Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
FaciGh Number Date of Visit: ' I Time:
18 Not O erational 0 Below Threshold
Permitted 0 Ce fled 0 Conditionally Certified DRegistered Date Last Operat or Above Threshold:
Farm Name: �%17_7/ �/IR105 �F IV� LLG County: Zn/
Owner Name:
Mailing Address:
Facility Contact: .SQ7.sf�(,/� �", `I Title: _o
Onsite Representative:, 5AA)7_Z:4ao 1%A2[ Uhl
Certified Operator:
Location of Farm:
6 Swine ❑ Poultry ❑ Cattle
Design'
,Swine-, Capacith
- ;JW Farrow to Wean
`3.M
Number of Lagoons
Phone No: o 76
/(, ^n Phone No:
Integrator: MtlitQ
Operator Certification Number:
❑ Horse Latitude Longitude =• 0. = -
❑ Other
-Total Di
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ZB
05103101
❑ Yes 'E� No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ;9No
❑ Yes VrNo
❑ Yes ONo
Structure 6
Continued

Facility Number: — Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
O No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
ONo
(It 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
VNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VNo
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
P No
Waste Application
10.
Are there any buffers that need maintenance/improvement? -
❑ Yes
E No
11.
Is there evidence of over application? ❑ Excessive Pond' ❑ PAN ❑ Hydrauli verload
❑Yes
VNo
12.
Crop type A71,Cl
13.
Do the receiving crops differ with those designated i e tertified Animal Waste Manageme lan (CAWMP)?
❑ Yes
o
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
b) Does the facility need a wettable acre determination?
❑ Yes
VNo
c) This facility is pended for a wettable acre determination?
❑ Yes
[;2rNo
15.
Does the receiving crop need improvement?
❑ Yes
O No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O No
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
EAO
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
VNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El Yes
VNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
PNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[rNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
PNo
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
�eNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
a.
Comments (refer to question : Eaplam any YES answers4fid/organytrecommendahons ormany other:cdmments 'F,
Use dra i gs of tacdrty;to better e'xplmn sttuafions (use additional pages is necessary) '�. •p
- ❑ Field Copy ❑Final Notes-
r,w,
�F G/✓ CDO j/fr�j�f. S��}iL ltyNS
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 v t Continued

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
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead anneals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes XNo
❑ Yes PrNo
❑ Yes Y,
0
❑ Yes �No
❑ Yes XNo
❑ Yes ❑ No
Additional ,Comments ,and/ork hings:, .., .
s �7E ; � L9e-w ✓ ��
X0 ^//?�
O5103101

Type of Visit Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit @'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: O % Time: q 30
1
Q Not Operational 0 Below Threshold
AlfPermitted 0 Certified ❑ Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name:,!?../`r�if!1./O®//1........................................................................... County:..:!.11. �.!_^.........................................................
........... ...................n
OwnerName:......... r~LDLCt-✓•�ti ............................... Phone No:.......................................................................................
.................................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
OnsiteRepresentative: .... 13.q.,GJ7. f�i/..9.;✓;¢!:}.......................................... Integrator:_'.._l:v/'joh ..rr-e-l'
Certified Operator: ................................................................................................................. Operator Certification NuJjmber:..........................................
Location of Farm:
gawme U rounry u came u norse ---
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry
....b......_ 1 1 t l i 1
uesrgu_, ...
Cattle _ Capacity;-F
❑ Other
TotaLDesign Capacity
Total SSLW: r-
Number of Lagoons Subsurface Drains Present �1❑ Lagoon Area I❑ Spray Field Area
Holding Ponds / Solid Traps �E:::� ❑ No Liquid Waste Management System
uiscnarees & Jtream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Struc�ore I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ....................................
...............................................................................................................
Freeboard (inches): 3O
5/00
❑ Yes No
❑ Yes 'HNo
❑ Yes -0 No
❑ Yes ) No
[]Yes jg No
❑ Yes 10 No
❑ Yes ;d No
Structure 6
Continued on back

Facility Number:.3 / — Date of Inspection (J1/ Printed on:
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 of
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?
1 /9/2001
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?
❑ Yes -frt'No
❑ Yes ONo
❑ Yes 10No
❑ Yes_)dNo
❑ Yes _TNo
❑ Yes I f No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONo
12. Crop type g� / r L✓�S H�+4 ) Sw.a G nq ih
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes _E!rNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes JZ(No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
���,,,,���"""
❑ Yes ldrto
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP, design,
Yes ANo
(ie/ checklists, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes 1 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?
❑ YesNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes Q'No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ONo
24.
Does facility require a follow-up visit by same agency?
❑ Yes ZNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 0No
)vo viQlafigris;ojr de£cie'ncie$ •wire itgfed d�rriit9 thjs;visit; Yojr ivjtj-�ecgiye tjq furt�tef ; •'
coriesporidence abovtithu visit: ........... .
t'ac:/;4b ziind recoro4S qre Very UXI / kepi.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

Facility Number: � — J l Date of inspection [ t"" 170, Printed on: 7/21/2000
(Mor Issues "`'���"'fff��"""'"""���"�"""'
%26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below _xYes ❑ 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 Jallo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes _J!fNo
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 IPNo
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'PMo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

Facility Number Date of Inspection I6—ly j I
Time of Inspection 24 hr. (hh:mm)
Permitted IO Certified E3 Conditionally Certified 0 Registered 0 Not O erational Date Last Operated: -„,,,_,,,_-
Farm Name: .........�Sl,L. \�`1i L—�K+� County:........ ���.:.1.......................................
OwnerName: ................................................... ................ .................................... Phone No: ---------------------------..___.___...
FacilityContact: .............................................................................. Title:................................................................
Phone No:..................................................
MailingAddress: ....................................................................................................................
Onsite Representative:.....�G`L.`.:...........................................
..................................................................................... .........................
Integrator: ........................ 0 ..........................................................
Certified Operator: ................................................... .............................................................
Operator Certification Number:................:
Location of Farm:
Latitude =• =' =11 Longitude =• =` ="
.11 Desrgn Curreof Destgn Current Design Current
Swtne ' , :Capacity'_ uhition Poultry Ca acr Po -ulation -.Cattle
ty_. _ ,.Ca aci +Population
Wean to Feeder �Q ❑ Layer ❑ Dairy _
Feeder to Finish Qd cs ❑ Non -Layer I ❑ Non -Dairy
arrow to Wean G G
„" ❑ Farrow to Feeder ❑Other-
❑ Farrow to Finish Total Design Capacity_:
❑ Gilts
❑ Boars -.
..Total SSLW
N6inbei� of Lagoons ❑Subsurface Drains Present ❑Lagoon Area, ❑Spray Field Area
-' Holding Ponds%.Solid Traps' ❑ No Liquid Waste Management System U
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) ❑ Yes ❑ No
e. 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 D(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IX No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P�No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches) ........_
...... ....................................................................................................................................................................................................
5. Are there any immediatethreats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �rNo
seepage, etc.)
3/23/99 Continued on back

Facilit Number:3j —' 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
WNo
(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?
XYes
QNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
jRrNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
W No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
;VNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
jNrNo
12.
Crop type 1�1� , rq
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
t4 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
allo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
VNo
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
4 Yes
❑ No
18-
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
KYes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
'ONo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
,4
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
NNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
D'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Ives
JWNo
LJ' N,6.Qibl'atiotis:or def ciencies -wer8 noted- d(Wii)g this:visit.' -:Yott will-i•eeeipe iio: further: -: :
. - . - coriesporideitce: abbot: this visit:::...:: ::::::::............... .
Comments (refer to question ffi " Explain an ;YES.ansswers and/ocan recommendations or any othercomments - "
Use drawings of facility" to better explain sitiiations (uaddititmaJ pages astnecessary
/ p\ �jGGti j -} rCt'@SL,
l�� fig) �o �w C-��-.Q� P-�� � C6 c �- hey-., �.•te- ��s�.
�1�. etc, •�G.s��t�\5,� + t�.��-e �1�c�� � �-cr��1i,L
-.
Reviewer/Inspector Name X996'
Reviewer/Inspector Signature: �j„-,_.L. L )�Al_ Nlv� Date: .6 —

Facility Number: — 1 S1 Date of Inspection old
Odor Issues tt��
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below �p 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?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
❑ Yes No
❑ Yes No
❑ Yes �IfffNo
El���
Yes �No
❑ Yes 0 No
XYes *(No
Additional or'. rawtngs:-- �- ;;..- -' > r,: s•Ha -.` �-
cw—� W�t�-� 9YQI,..e,� ��er— •�t���+�'� �`i'i�-���
-
Qb�

LJ urvrswn or aou anti vraier conservation vperayon nevrew +.
. Q Division of Soil and Water Conservation Compliance Inspection s
Division of Water Quality 'Compliance Inspection r
0 OtherAgency Operation Renew
Routine
Facility Number I Date of Inspection 161?_�
Time of Inspection t5G 24 hr. (hh:mm)
*Permitted [3 Certified 0 Conditionally Certified Q Registered Not O erational Date Last Operated:
Farm Name: .... _1?1.1a V- wcjct County:..... ....................................................
r' '��"�
...............................................................................................................................
OwnerName:...........1.Q.........`.... I....\............................................................................... Phone No:.......................................................................................
Facility Contact: ... 'J..�IUL ....-4-`."�................... Title:..........�!f.�!�....................... Phone No`d'�{}_'-l.....
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
OnsiteRepresentative: .... \_e:....`!.Y......�..V'�h............................................. Integrator.,..,J. \�-+ .
Certified Operator: ................................................... ........................................ .................... Operator Certification Number:..........................................
Latitude =•=' =• Longitude =• =' ' =11
Design
.,.Swine -- ` : Capacity
Current.''Design .. - Current. ; -''' ` _ Design Cui•reut ,.
Population Poultry , ` ' '''Capacity . Population -_ CattleCapacity Population-'-"
❑ Layer ❑ Dairy "
❑Non -Layer ` ❑Non -Dairy "
❑ Other _
Total Design Capacity
.
Total SSLW
can to Feeder
"(GO
-
Feeder to Finish
-_Farrow
to Wean
❑ Farrow to Feeder
[]Farrow to Finish
.
❑ Gilts,
❑Boars
'Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area �.
"= Holding Pond's Solid Traps �' ❑ No Liquid Waste Management System7.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes IX No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 15�No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: U1
Freeboard(inches).............:..!..I.............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes 'E�No
seepage, etc.)
3/23/99 Continued on back

//Facili v Number: 3 — `q Date of Inspection
Kt. 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 Pending ❑ PAN
12. Crop type '_' . SCI
WNo
❑ Yes
❑ Yes
bjrNo
❑ Yes
b�(No
❑ Yes
1Y No
❑ Yes
9No
❑ Yes
Z No
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?
Were any additional problems noted which cause noncompliance of the Certified AWMP?
iVq yibl'atiotis:or deficiencies were honed• ditriitii this:visit: • Ypit wi1l,reeeiye Rio further • ;
-correspondence. about this visit: ::........................... .
❑ Yes O No
❑ Yes 4 No
❑ Yes Z No
aYes ❑ No
MYes ❑ No
❑ Yes IgNo
❑ Yes O�No
❑ Yes [f No
❑ Yes t9j No
❑ Yes gf No
❑ Yes 0 No
❑ Yes )o, No
ElP! Yes No
❑ Yes (�I`No
❑ Yes t 'No
Q�Y-A-s 0--\—
�L � Z �e f � s �� S��lssed 'tl.\, 4, ce�t�y,Z is tale
s
4o ie, e`rr�}c1L@rlStn hey
\U L 46a-A Gt-� ke-el�7 WV
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
3/23/99

Facilijy Num Date of Inspection
odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
MNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
✓cf 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
1�(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
N-No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
A -No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
tYes
❑ No
3/23/99

- �_4' ;V,5 = x
Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Numbe
Farm Name: cv oc r,
On -Site Representative: a, Oar
Ins pector/Reviewer's Name: L-4e
Date of site visit:_ �6 12-d- q
Date of most recent WUP: ,X
Annual farm PAN deficit: a,CJ63 pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility item(s) F1 F2 F3 F4
Operation not requirei$ to secure WA
determination at this time based on
exemption E1 E2 E3 E4
V Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #.1�Dhard-hose traveler, 2. center:pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part II, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D�D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part III. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part III).
PART 11.75% Rule Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required.because.operation fails one of the.eligibility
requirements listed below:
F1 Lack ofacreage :which Tesultediniovermpplicationmfwastewater(PAN) on:spray.
field(s) accord ing3oiarm'slast two years mfirrigation-secords.
F2 Unclear, illegible, -or lack of information/map.
F3 Obvious field limitations -(numerous:ditches;failure3o:deductTequired.._
buffer/setbackacreaae;-or25%:offotai_acreageddentifiedin CAWMP=includes- .
small; -irregularly shaped fields = fields:lessthan-5acresfortravelers-or.less-than
2 acres for.stationary-sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage in excess
of 75% of the respective field's total acreage as noted in table in Part III.

Facility Number_Revised April 20, 1999
_. -
Part III. Field by Field Determinatinn of 7FOi G,.D.,.. f;: _ o..r,.:.._.e,A .,
TRACT
NUMBER
FIELD
NUMBER'-2
— — -
TYPE OF
IRRIGATION
SYSTEM
-
TOTAL
ACRES
1-- 1-- 1-1
CAWMP
ACRES
WA uecermmation
FIELD
%
COMMENTS'
1s GU
i
19
Ut�CI--I
g-S
FIELD NUMBER' h .i t n
r- �• r� ___ __�===ter s may De usea in place of field numbers depending on CAWMP
and type of irrigation system. If pulls, etc, cross more than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; otherwise operation will be subject to WA determination.
FIELD NUMBER' - must be clearly delineated onCOMMENTS'- back-up fields with CAWMP acreage-exceeding-75% of its total.acres and having received less than 50%
of its annual PAN as documented in the farm's previoustwo years' (1997 & 1998) of irrigation records, -cannot serve as the
sole basis -for requiring a WA Determination. hack-upfields-must be noted in the comment section and must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
P1 Plan lacks
P2 Plan revision may:satisfy-7.5% rule based on adequate overall PAN deficit and by
adjusting all field:acreageto below 75% use rate
— P3 Other (ie/in process of installing new irrigation system):

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
[WRoutine 0 Complaint 0 Follow-upof DWQ inspection V hollow -up of DSWC review V Other 1
Date of Inspection 23 g
Facility Number Time of Inspection io 24 hr. (hh:mm)
0 Registered I$ Certified 0 Applied for Permit E3 Permitted JE3 Not Operational Date Last Operated:
Farm Name: ........ ccj . ? ti^....._IL......................................................................... County: ...
D0�1.91.......................................... .......................
OwnerName:........... .....�.).'.!ti 5............................................................ Phone No: .... L9KY. A3=316)...........................................
Facility Contact:...... tip. .......W..My.t.A ............................. Title:.......M..."?r................................... Phone No:...................................................
Mailing Address:..............:aXStwJ....l _Nt%........................
R............................................... ...................... ...�.�.........
Onsite Representative: ......5]4 i4q.... wa this-- ...................................................... Integrator:.......... !(.th'.'1i�,�....
Certified Operator:.............................................................................................................. Operator Certification Number, ..... ;�o_V W�.............
Location or Farm:
W.1....st...ar....xt ...... s.;.e:... a# .......... .:13o1...t... I ... ra .... enact..'A... .SF, ...l..ki..............................................................................................
.
...................................... ........ ...................................... .......................................................................................................................................................................................
Latitude �•_�'�" Longitude �• �'�"
%' `"Design s Current = a -:'Design s Currehf--- Design -Current
'ISwine _ Capacity Population ,Poultr"v Capacity Population Cattle =,' Capacity Population
Weanto Feeder
Feeder to Finish
0 ,
Farrow to Wean
'y ❑ Farrow to Feeder
-, ❑ Farrow to Finish
❑ Gilts
❑ Boars
JLJ Other
."T
No Liquid Waste
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 ;aUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? .
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
Spray Field Area,;
❑ Yes ® No
❑ Yes ® No
❑ Yes W No
❑ Yes R No
❑ Yes Ep No
❑ Yes
® No
❑ Yes
® No
Yes
❑ No
❑ Yes
tl No
❑ Yes
No
Continued on back

Facility Number: a I —
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes 10 No
Structures (LaQoons,Ifold inu Ponds- Flush Pits, etc`.) _
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes C1 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:................................................................................................................................................................................
...................................
Freeboard (ft): .......... 2. �.
......................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
M No
11.
Is erosion, or anv other threats to the integrity of anv of the structures observed'?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
,Yes
Ug No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate, minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application '
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or entering waters of the State, DWQ)
15.
runoff Inotify
Crop type ........... 9� vy. �...A�SS.......... ........!C9.G........ ......... .... � t, — (................. ........................ ..................................................................
........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
M Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
[9 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
._
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
V Yes
lP No
25.
Were any additional problems noted which cause noncompliance of the Permit?
CAI Yes
® No
0 No.violations or deficiencies were noted during this. visit. receive no further
I.. about this visit..
Comments (refer to question #): Explain any YES answers and/or any recommendations of -any uther comments
Use drawings of,facility to better explain situations. (use additional pages'as necessary):
sly IJ 6& vno�acl txrtlay �.eT �yd4A+N
,z- cwoslom to to or- "kl-- dtll-L wail dF (w,c>,t- SWA (new fillo a J bvwdeJ. GaKL
S6,m�IJ be �Ct t cJ of-- 4 (acfilaci kt,.
C krAJO- S(nta:-ltt] 6t S?rt�rye"t'y Xi soon- at-s.t pos5ib(e. q
0.+w�gSis �vVtQ rrswO'LS�SY, slJ be zn �Oth•
P�Cld Ftz. Wa 5,V p l; ca�iens �
r,tJ-Mardt- {o �r uv,+- �d kc `corded beik� „„C"P, 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: ZSn.�__. //%,- � Date:

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor L
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Ecosystems Farms Inc
Ecosystems 42
1184 Veaches Mill Rd.
Warsaw NC 28398
Farm Number: 31 -197
Dear Ecosystems Farms Inc:
MAR 2 3 1998
March 20, 1998
AA
Z4 Ae
ftftwoM
rokv
You are hereby notified that Ecosystems #2, in accordance with G.S. 143-215.1 OC, must apply
for coverage under an Animal Waste Operation General Permit. Upon receipt of this letter, your faun
has sixty (60) days to submit the attached application and all supporting documentation. In accordance
with Chapter 626 of 1995 Session Laws (Regular Session 1996), Section 19(c)(2), any owner or
operator who fails to submit an application by the date specified by the Department SHALL NOT
OPERATE the animal waste system after the specified date. Your application must be returned
within sixty (60) days of receipt of this letter. Failure to submit the application as required may also
subject your facility to a civil penalty and other enforcement actions for each day the facility is operated
following the due date of the application.
The attached application has been partially completed using information listed in your Animal
Waste Management Plan Certification Form. If any of the general or operation information listed is
incorrect please make corrections as noted on the application before returning the application package.
The signed original application, one copy of the signed application, two copies of a general location
map, and two copies of the Certified Animal Waste Management Plan must be returned to complete the
application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
Post Office Box 29535
Raleigh, NC 27626-0535
If you have any questions concerning this letter, please call J R Joshi at [phone] extension
363 or Dave Holsinger with the Wilmington Regional Office at [phone].
cc: Permit File (w/o encl.)
Wilmington Regional Office (w/o encl.)
Sincerely,
zo/ A. Preston Howard, Jr., P.E.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number ')
Farm Status: ® Registered ❑ Applied for Permit
❑ Certified ❑ Permitted
❑ Not Operational Date Last Operated:
Farm Name: �4S114. —Kne.At. 3...�x�... .... ._..... ........ _.....
.
Land Owner Name:.. .....--.....----...._...-- - -- --
Facility Conctact:... $s�i�.... ....I,ty�Y.._Ye^^_-...._-.. Title: ......... .........
Mailing Address:._..Y.__1-.f......... ..1.. ..?j.........._....__......_....._._.....__......
Onsite Representative:...I
�jc�.t �.q�..__.. r���_..___..___......�..._.
Certified Operator:.... ,............E.M. .E-L
Location of Farm:
County: _Did, ... tkt...... _...... ............ .... .1�!x.�Q
Phone
Phone No:.._�`1.�_�i 3..-.�.J,5 1
IAra�4�...... f, .....__...._._.... Z.8. 4.�.
Integrator:_ ux �t
Operator Certification Number.
Latitude Longitude F Foo 1-1�
Type of Operation and Design Capacity
Sw.oe Ctitrrent;= Design Current Design Current
Poultry -Ca actty o ulatton E Cattte -CZ
Ca act Po ulittaon
❑ Wean to Feeder I❑ Layer ❑ Dairy
❑ Feeder to Finish ❑Non Layer---'ij[1Non-Dairyj
Farrow to Wean v ,,
Farrow to Feeder Total DestgnCapacityal
�
Farrow to Finish 4
❑ Orher _ Total SSLW • 2 Zo
erg _..
Number of Lag ons %H to drag Ponds Subsurface Drains Present"
, e
' Lagoon Area = ❑Spray Field AreMa
�..
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes 18 No
❑ Yes ® No
■
❑ Yes ®,No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
[Yes ❑ No
Continued on back

Facility Number:,_,,,,_—„f_q_
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Iioldina Ponds]
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (8): Structure 1 Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
fio No
❑ Yes
91 No
❑ Yes
& No
❑ Yes
IR No
Structure 5 Structure 6
❑ Yes
EqNo
❑ Yes
Q No
B Yes
❑ No
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 _�i.fcc .v m.....-....ari% �x�.ct.cn W...._ t.e S_� al..t.............. ..... -...... ...... ........... _......
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?
For 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 f $ No
❑ Yes IR No
RYes ❑ No
❑ Yes 9No
19Yes ❑ No
❑ Yes IgNo
❑ Yes ® No
❑ Yes ®•No
❑ Yes EfNo
❑ Yes ® No
® Yes ❑ No
Comments(refer to question Explam any YES answers and/or any iecoinmendabons orany other,comments —
Use drawnngs�of facthty to better explain situations, (us•e additional pages as necessary)
5. 1$, Rc� iv4e C.O., + I P_ (roa i ar`t.e_� wtil. av gpPraPrIa 4
C,oJyr Mir "� n Sfr f-i 0,IJ4. IZ• RW Rtw cG YN)"rR- `'r T' iF
Ycc cwt le- p,tk oof 0J-t — 1 00-6• LA.)aII GI n tra 1t
IL. A •ten.5 PIa,. is b`qy devcl0 +L,�
p l a v. h e t4 S I -a b y cQ rJ l e #P-t( 4 s -Soo >n aj P VS S b S n
{�C, I r Vt•a{ 0.�ren�_,`l- ac�o v`l'�S L� S•
2NY . ►naclvC i-,cld tovn.v2 the he.J �^^wv�ayQiMa n¢ p1w�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
cc. Division of Water Quality, Water Quality Section, Facilitv
Unit
Date:
aiznio•r

Site Requires -Immediate Attention:
Facility No. 1— 14
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 [ 7 1995
1 Time:
Farm Name/Owner: ECD 5451 Qivn 5
Mailing Address: 170 EX73f isa ZF45"7
County: R o k o
Integrator: Phone: Z -
On Site Representative: I e5 mcore. Phone: Zc13 - -:�oS
Physical Address/Location: I ( 94- Ve-2rh rS fib; • WZngkd Z65V
is2 1307 N 1.7— mI' rron 521304- . 6n Iefi-�
Type of Operation: Swine Poultry Cattle Sow Farm
Design Capacity: �2400 5t'ru5 Number of Animals on Site: 355(P SOW5
DEM Certification Number: ACE_ DEM Certification Number: ACNEW
Latitude:3° CA 'a•S1" Longitude: -78 ° C-0 ' 562" 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) es r No Actual Freeboard: Z�Ft. 60 Inches
40 Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Yes o No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes r No
n
Crop(s) being utilized: r3Z r-l-"
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream?. Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orEo)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ot� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)(Yes r No
Additional Comments:
Lind-)
Inspector Name
Signature
r1
cc: Facility Assessment Unit Use Attachments if Needed.