310200_INSPECTIONS_20171231

NURTH CAROLINA
Department of Environmental Qual

2vo
(Type of Visit: QjCorppliance inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit7Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Lf Departure Time:® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: I ✓ C S ��a i /�
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator• q
Certification Number: I \ J
Certification Number:
Longitude:
Swine
Wean to Finish
can to Feeder
eeder to Finish
Design
Capacity
u oa
I0 o q
Current
Pop.
Q
1 D 0.0
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Da Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
3 SOD
3714 c
I)r. + P.oulh.
Layers
Ca aci_
ren
P.o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
lBeefBroodCow
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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes / No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Numhar: 31 - 0 Date of Inspection:
7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑4No
❑ 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): —� 39
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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 L7 i"o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [/] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E3 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E]-<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
]�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CTNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ED-14o
❑ 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 o ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - 209 jDate of Inspection:
24. Didthe facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ 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 I T NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ NA ❑NE
❑ YesrTNo
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other. comments
Use drawines of facilirvAo better eiolain situations (use additional oa9es as necessary).
C
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Zi p/p ��� rG�L L/r2n pe
.70
Phone: q P
Date: tf 7 r%
2141201;

t ype of visit: t-4Comp nce inspection u uperanon tcevtew u structure Lvamanon %J t ecnmcat Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p Z / Arrival Time: ® Departure Time: , o County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Q 1/ r
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Region:
Certification Number: 11 1 S 7
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Curren[
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
an to Feeder
400
Non -La er
DairyCalf
eeder to Finish
009
7v> 9
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
53n
D
Dry P,oultr,
Layers
Design
C_a aci.
Current
P,o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes [—]No
❑ Yes [—]No
[—]Yes
❑ Yes rNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 21412015 Continued

Facili Number: 2Oo Date of inspection: /� 2
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑'5o­ ❑ 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): r/
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0No ❑ 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 ETNo ❑ 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?
8. Do any of the structures lack adequate markers as required by the permit?
(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
maintenance or improvement?
❑ Yes QNo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [! f No ❑ NA ❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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
Ef No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑/ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
eNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
En No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[4'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[6 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[,77J-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[N
❑ 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 Number: LD n Date of inspection: I ti-177216
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ErNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E] 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? [—]Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
ILIA ❑ NE
❑ Yes E]'No ❑ NA ❑ NE
❑ Yes E2 No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes 0 NNoo ❑ NA ❑ NE
[—]Yes
No
❑ Yes
❑'Po
[:]Yes
[-d""
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
IS roc e tP�{ro(���`e/�'s
J
C►. ht,.�� _ l0-__(S,6�
�p �f�c�.cwC rya✓ �li 1 �PC` rn�a �%/✓�\ale
Co
p«s �' sl buy P.P/'/�.
L �� �R G /40 � e /( � C O'eJ '
CI Jk S�e i 4 S Cry S�r—r� nc �'7f �a{, it
I4C,7 r�5 tr, � $oA ? 0 A_ir, re,
Reviewer/Inspector Name:
u.- l IfP`
Reviewer/Inspector Signature: avw"
Page 3 of 3
Phone: to 7 9 73�
Date: n 7-
2/4/ 014

(Reason for Visit: - Q2f-Rro-uuttine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I 7/Zb //) I Arrival Time: 10� Departure Time: )'Z County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 5/t' 7 Hatlrr
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: ) d1 q 5-7
Certification Number:
Longitude:
Swine
an to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Lae
Design
Capacity
Current
Pop.
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
490
O 1
INon-Layer
I
Dairy Calf
F der to Finish
arrow to an
Farrow to Feeder
Farrow to Finish
I1xX)
3Sao
70.0
o'I
D .+ P,oult ,
La ers
Design
Ca aci
C•unrent
P,o P.
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ]�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ENo
❑ Yes [�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

acili ,Number: - %09 jDate of Inspection: L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
o T
Spillway?:
Designed Freeboard (in):
r Observed Freeboard (in): 1? 3 � q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesVN'(
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? []Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ'No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ej'�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
0 N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FJINo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Oth
21. Does record keeping need improvement? If yes, check the appropriate box below. El 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 ' No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes do -❑ NA ❑ NE
Page 2 of 3 21412015 Continued

J;acitity•Number: - iJ7.? Date of Inspection: 2 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check es ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Q Yes [:]No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E�J A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 0No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes E2rl�o ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
❑ Yes
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question,#): Explain, any YES answers and/or any additional recommendations or any other comments. I
.., _ _
Use`drawmes:of facilitv`to bettei eaolain situations tuse'additional oa¢es as necessarvl.
zS 6R4 Copy, 4 etc"" of- ac+k-'(5/(4jje) a,,.j frwt��y y co Pr
4� p6", 0K} Cgey >4Alk R<"orJg
2G ca(YoG o1'C Corit 20/Sul"Z ��flr.Ii«, lt�.xAs
RerlueTye�s �-� Cer,,0�4 Jrr(f_j'A0A �g l
FIX if 11(0 350 z°w
W" ^ 00'rl j
NG0e1✓P- .anal oGF�G
e. r9}�r Reg
cc
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
(:)� , t e `/q _—'e,
Phone: I10 714 7-joy
Date: s/ 42 11 j`
21412015

(Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit �Denied utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Time: Departure Time: County: - la— Region:
Physical Address: rtam�..
Facility Contact: , _C.Y_ W'Q--cb Title:
Onsite Representative:
Certified Operator: —
Back-up Operator: _
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: L o [7, F Longitude: Mo[�, Q
12estgn Current Destgn CurrentFE
D tgti Current
Swine.
o Gapactty
Po `ulahoq Wet Poult
p ryCapactty Population
Cattle
n$Capa�tty
Population
❑ Wean to Finish
V 10 Layer
I
Dairy Cow
I-`
❑ Wean to Feeder
❑ Non -Layer
I
❑ Dairy Calf
❑ Feeder to Finish
"'" `""—'" - _
�� ❑ Dairy Heifer
❑Farrow to Wean-"
""'' ""` - "`
..,.. ❑ D Cow
kDry Poultry
❑ Farrow to Feeder
�� ❑Non -Dairy
❑Farrow to Finish
'FE]Pullets
❑ Beef Stocker
❑ Gilts ers❑
Eli
Other ❑Turke Poults
Beef FeederBoars
_ ❑ Beef Brood Covd
❑ Other
El Other
m o
f1Struc "N
be1
tures.
,,,,,
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 RfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
[:1 Yes ,] No
❑ Yes
m No
❑ NA
❑ NE
[]Yes
[/No
❑ NA
❑ NE
Page I of 3 12128104 Continued

lFacility Number: I i - '-� 00 Date of Inspection: z z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
V No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[]No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_{p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
7 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
2fNo
❑ 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
VINo
❑ 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?
❑ Yes
PrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
l /l No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[ZNo
❑ 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
Inspectio___n,,ss,,,
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
J TYo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of
21412011 Continued

FaCiti Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe it? [:-]'Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes Z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 1XNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes VI No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[1] No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[M No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J ] No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CZ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes
[6 No
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.. ,AI
Use drawings of facility to better explain situations (use additional pages as necessary. ).
IV 27 /l L
rarer
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1c._7
Phone: P1j - 7?Z_; — 7y36
Date: ,7 ZZ Z,
21412011

IType of Visit ,QfCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit.Routine 0 Complaint O Follow up O Referral o Emergency 0 Other El Denied Access
Date of Visit: W�au Arrival Time: Departure Time: County: lle Region:��
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / Title:
Onsite Representative:��ve: �
dS
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
yPhone 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?
❑ Yes f ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
WNo
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

•Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �TNo ❑ 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: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Callo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 5rNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑^No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P.M
❑ NA ❑ NE
maintenance or improvement? 7
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesXNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o
ElNA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ElHeavy 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 ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes 2]�No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ;Z No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑Yes No
ElNA
❑ NE
Comments (refer to question #): Explain,anyYES answers and/or any recommendations -or am other comments
Us`eidrawings`"of facility to better explain situations. (use additional pages asnecessary):
'01- /GGer�r �Od��o
IReviewer/Inspector Name I Phone: �j — I
Reviewer/Inspector Signature: _ __/ Date: 3 /;;62 /'�'3
Continued

facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �o El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes Z( INo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes d-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
O No
❑ NA
❑ NE
-23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,yff
,1 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2INo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�] No
[INA
❑ 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
VrNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
[INA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
91 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional,Cumments and/or Drawings
12128/04

Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 11>Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: �eparture Time: County: /Yt, Region: 41d�
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �t.IC lit-IleI s
Certified Operator:
Back-up Operator:
Location of Farm:
�y Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: F70 F7' n " Longitude: ' I' I I-1 11
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
JLJ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
El Pullets
❑Beef Feeder
❑ Boars
❑ Beef Brood Co
❑ Turke s
Other
111E]
❑ Turkey Poults
Number of Structures:
Other I I
❑ 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 �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
No
Yes
El,L�
,❑l
IINNo
❑ NA
❑ NE
❑ Yes
,
No
❑ NA
❑ NE
12128104 Continued

Facility Number: —dCd 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 PNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [rNo ❑ 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 UNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ___
9. Does any part of the waste management system other than the waste structures require El [A No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'P�No ❑ 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 Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes pNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
;3No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Er 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
PNo
❑ NA
❑ NE
Comments(refer to question #) 'Explainany YES answer and/owany recommendations or any oth rtcomments�
r^ a
Use drags of facility to.better`explam situations (us'e addthonal pages as necessary) , - winoCJ+`kx�
Reviewer/Inspector Name j Phone: —c�p7
Reviewer/Inspector Signature: Date: O
810 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )dNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ 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
VTNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
TTXNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
[INA
[INE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
V�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
0 No
❑ NA
❑ NE
12128104

IType of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit ZRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: �.a.3 Departure Time: County:
Facility Contact: —�� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: 4r ftDo,
Latitude: [=o='=„ Longitude: =°= =u
Design Current
Design Current
Design Current
Swine Capacity Population
We[ Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer 1
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
El Layers
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
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 VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
[I NA
[I NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ON
�No
ElNA
ElNE
❑ Yes
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ! n
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 10 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): , r�
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ONo
❑ 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
rNo
[I NA
[I NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
[I Yes
,
/LI No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require
v
❑ Yes
PrNo
❑ NA
❑ NE
maintenance or improvement.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑-No ❑ NA ❑ NE
El Excessive Ponding El Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.) //
❑ PAN ❑ PAN > 10% or l0 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 „u No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
EI No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo
❑ NA
❑ NE
C°mmentsr(r�efer toyqueshon #) Explamrany�PES,answe`rs and/or any recommendahonsror an
y other comments.
ns _ C 4i tit
Use drawings of facdrty fo better�explam situ o(use+additional pages as+necessary):
Reviewer/Inspector Name IZ2- Phone:
Reviewer/Inspector Signature: Date: O
Pnao 2 of i 12/28/0 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PrNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
4No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
16No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
A 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
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
"No
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�TNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,..,�I
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L(1 No
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
�No
❑ NA
❑ NE
Additional -Comments and/,or,Drawtngs ,fu ; # '¢* r£
Page 3 of 3 12128104

• ,Facilt 1Vur
Type of Visit �QJCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit -Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t7 Arrival Time: Departure Time: County: __5�2 Region:42/zz
Farm Name: -Z
Owner Name: —
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: -� Title: Phone No:
OnsiteRepresentative: Integrator:_���
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = U = ' = Longitude: = ° =' = "
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Ggppci Population
❑ Wean to Finish
1 10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
JLJ Non -Layer I
❑ Dairy Calf 1
11'
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Dry Poultry
❑ La ers
❑Non -La ers
❑ Dairy Heifei
❑ DryCow
❑ Non -Dairy
El Beef Stocker
❑Beef Feeder
❑ Boars
Other
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Beef Brood Co
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
if
El NA
❑ NE
❑ Yes
(_J No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 12 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):i�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YeF, 0 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 ;21Qo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[:]Yes 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 fj�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
rryy55
El Yes Z No
❑ NA
❑ NE
maintenance/improvement? ,,,,LL,,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[,;�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P'NTo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
Vr—No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
[]Yes
No
ElNA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
,E
EI 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):
4�°� ®
oY 99
7/0— 3.moo -20CV
ply/
��edln Ra�.il6,,�
Rlc�- 3Sv��40�/
/�
Reviewerltnspector Name
Phone:
Reviewer/inspector Signature:
Date:
12128104 Continued

u
0 Division of Water Quality /
Facility. Number 0 Division of Soil and Water Conservation ;
— _ — - 0 Other Agency
Type of Visit F=pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: t'o Arrival Time: Departure Time: County: (LC� Region�iJ��'F�
Farm Name: Q�I�! 9A) &%yi Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��C-.i �4�✓�
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certifiea[ Number:
Back-up Certification Number:
Location of Farm: Latitude: o Longitude: o
r
Design Current Design Current Design Current{ -
Swine ` Capacity Population .:Wet Poultry Capacity Population Cattle - Capacity Population
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
ter
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes PK�to ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[�TNo
❑ NA
❑ NE
❑ Yes
y No
❑ NA
❑ NE
12128104 Continued

Facility Number: — UQ Date of Inspection
V�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: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3j
S. 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 P No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [7No ❑ NA ❑ NE
❑ Yes LdNo ❑ 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 [INo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U�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 PTNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E)Ao ❑ 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 l
12. Crop types) /nJr�v. �OdG�PGH S� / tern ��/�ni 1��S�%/iaPrt�� /
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
PNo
❑ NA
❑ NE
No
❑ NA
❑ NE
PNo
❑ NA
❑ NE
[� No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any ottier comments.4
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 1 Phone:
— El
Reviewer/Inspector Signature: Date: Z
6
Page 2of3 IZ128104 Continued

Facility Number: — Date of Inspection 3 i7 6 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
9No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O'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
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PdNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
"O�r/ a -
Page 3 of 3 12128104

Type of Visit S%Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 'Routine O Complaint O Follow up 0 Referral O Emergency �0 OOther ❑ Denied Access
Date of Visit: 3 G Arrival Time: : QQ Departure Time: County:.f/D��h- Region: v%
Farm Name:
Owner Name:
Mailing Address: _
Physical Address: _
Facility Contact: J Title:
Onsite Representative: W� 1 [a,
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
01✓ean to Feeder
2teeder to Finish
arrow to Wean
EJ Farrow to Feede
❑ Farrow to Finish
❑ Gilts
F1 Boars
Other
❑ Other
Design Current ,
Capacity Population
Owner Email:
Phone:
Phone No:
Integrator: 11_1111/JW04 n
Operator Certification Number:
Back-up Certification Number:
Latitude: [o =, Longitude: M° �
Design Current Design Current
Wet Poultry Capacity Population Cattle Capacity Population
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: FTI
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 �Krr , ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0*14o
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
12128104 Continued

acility Number:3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: [ 2"
Spillway?:
Designed Freeboard (in): l
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�TNo
❑ 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?
I bl f d k Al-
❑ Yes
2No
❑ NA
❑ NE
(Not app tca a [o too e pns, dry stac s an or we stac s)
9. Does any part of the waste management system other than the waste structures require ❑ Yes y(�,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f;2)No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drifl [:]Application Outside of
Area
12. Crop type(s)1�
13. Soil type(s)
14.
i
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 ❑1o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes Z lqo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes ,01to
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes ONo
❑ NA
❑ NE
IReviewer/Inspector Name (` caa l�&l%',' ` Phone: I
Reviewer/Inspector Signature: 2— %'�� Date: 6

Facility Number: 3 —/9CO I Date of Inspection I /�ZU I
Reguirtd Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [21No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 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 �oNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes / n No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes,,I
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 001
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑,No
El NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes Q-No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes J1No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes fNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ENo
❑ 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 -2'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes j 'I
❑ NA
❑ NE
Additional Comments and/or Drawings: , -
-
�e�or�s viea-�
12128104

(Type of Visit 0 Corppliance Inspection O Operation Review O lagoon Evaluation I
Reason for Visit G�/Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility NumberNate of Visit: 1 6 Time: 960
0 Not Operational O Below Threshold
Permitted dCertified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: NAZ ZR S_�ov) _�_ --�-- County:
Owner Name:
Mailing Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: _plLL4rj HAI&Q= Integrator.
Phone No:
Certified Operator:----.. __ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =' =_
Desrgn '='Currents 3,:- Deagn Great Deaga M1 C�rent
Swine Po Ca'acr =Po ::Cattle as 'Po olahon
:Ca a ufatiou_„'Poiiltry_i=,.. .. ulahoa „Ca
Wean to Feeder ty a o `/ _ Layer Dairy
-
Feeder to Finnish
1666
gS%
❑ Non -Layer
Non -Dairy
Farrow to Wean
o O
14760
Farrow to Feeder
Total Dtstgn C,apactty
Farrow to Finish
_
of
Gilts
z T0W1SMW:'
Boars
- NmaiberE�.Lagbons , x
I Hold
�-�
6i'P6&W_1S,6M X-nms
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _-- I IL__ _ ___ _—.
Freeboard (inches): yS 37 _
12112103
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑6o
❑ Yes
dNo
❑ Yes
[/No
Structure 6
Continued

Facility Number: 31 — 2e�a Date of Inspection t 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑yes
Q No
seepage, etc.)
/
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
U No
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
J
7. Do any of the structures need maintenancelimprovement?
2 Yes
❑
8. Does any part of the waste management system other than waste structures require maintenance/rmprovement?
❑ Yes
'No
Q'No
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑'No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
0'�o
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 i E S Ga Ili
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
tN9FNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
El Yes
15. Does the receiving crop need improvement?
❑ Yes
No
Wo
16. Is there a lack of adequate waste application equipment?
❑ Yes
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Uvf o
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 do
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.
Feld
1.) c4NTZ4Ue GZASS CO\*r-, warty a..l LAC-,wrj,l I
3s.) WeCX LA&ooO WI1L1. AFtUl— I" "Xt)rALL
rp r=.'vn L"lc-t Gfoop.
Reviewer/Inspector Name
Reviewer/Inspector Signature: iwAV Date:
tl
Final Notes
im[civu wiwws.scu

Facility Number: 31 — Ub Date of Inspection
Required Records & Documents
•21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/
(ie/ WUP, checklists, design, maps, etc.)
Ely es
0
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[j 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
❑N
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
7N9
(it/ discharge, freeboard problems, over application)
❑ Yes
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
11No
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
0
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[�To
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) [7Yes ❑ Nq
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes — o
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes �p
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes o
34. Did the facility fail to calibrate waste application equipment? ❑ es Lr No
35. Does record keeping for NPDES required forms need imp ement? If yes, check the appropriate box below. p Yes El No
❑ Stocking Form El Crop Yield Form ❑ Rainfall p Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted daring this visit You will receive no farther correspondence about this visit.
Ndditibitil @omment and/oiDrawinS s 2
12112103

(Type of Visit O Compliance Inspection 0 Operation Review O lagoon Evaluation
Reason for Visit O Rouline O Complaint O Follow up O Emergency Notification t5 Other ❑ Denied Access
Facility Number Nate or Visit: Tune:
�Pe/ O Not Operational O Below Threshold
Qrmitted E(CertiSed 13 Conditionally Certified ❑ Registered Date Last Operated or Above reshold:
Farm Name: 1_!!^..:.County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
OnsiteRepresentative:Integrator:
Certified Operator:��_�__
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =` =- Longitude =• =' =�
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) El Yes ❑ No
C. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Idendfier: __ I_ __ ILI
Freeboard (inches): 3-5 37
12112103 4 Confirmed

Facility Number —ob Date of Inspection 8 0
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 ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? E3 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Aonlintion
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
1 I.
Is the evidence of over application? If yes, check the appropriate box below.
�cessive
❑ No
Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type ?> t rt.wA vDa. C G %�
N 1 5Ca0 'i s 0
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
WuaaaRuu ll4 ier WHO) �y ila7 answers,
�"J :4r r.,�tllR �WYacuVl. � __m:v..., ••
Use;drawmg� otfaaTtty to bettere>cplam sutnatiaas rase aaamomtspagis as necessary) -t Field C ❑ opy ❑ Final Notes
jl� �teSS,VC� roKCN4et orb b0.� -!.� °� �v�� ([.�, t'JY✓�QinS itit�Y.*?' �
e". Simloa fro, 90N 17'em,
vl� Wnl Sprt� 43er-+w�d� 'tILItI'°y
t�Ir r WvP r 6�r - �{
1 _LLs I, � ° l IIq 611
sn;.l r (s C�'.VtVal %kr IA 46r.
Reviewer/InspectorName � ��- O ►�...`�Et.AIEZt'� .��� ''' �`-����-
Reviewer/Inspector Signature: Date:
Belau. Loyauuma

I.Ficility Number: 31 -2001 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(id WIT, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as requited by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/i ispection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall []Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit You will receive no further correspondence abort this visit
12112103

Type of Visit ZCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 12 ✓Routine 0 Complaint 0 Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 t 7O Date of visit: ! dL Time:
Not Orierational 0 Below Threshold
13 Permitted ❑ Certified 0 Conditionnally Certified 0 Registered Date Last Operatel or Above Threshold:
Farm Name: i/✓ I 5e0 r wift County: agurk
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: I"JWkt✓
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: &Nd w
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0'=• =u Longitude 0' =, 0-
Design Current - 'm Design `Current - Design Curreni
Swines. s .Ca acit% :Po elation Poultry _Ca acity Po ulation= Cattle - Ca acity. Po ulaLon
Wean to Feeder ❑ Layer i- 10 Da
Feeder to Finish D '"_ ❑ Non -La er ;. ❑Non -Dairy -
Farrow to Wean-
❑ Farrow to Feeder -` ❑Other - -
❑ Farrow to Finish Total Design Capad iv
❑ Gilts
❑ Boars Total SSLW.'
Number of Lagoons ', ©1 = �) ❑Subsurface Drains Present ❑ Lagoon Area 10 S rav Field Area t=
Holding Ponds Solid Traps „; ;�, - - s; ❑ No Liquid Waste Management System - -
Dischar-es & Stream Imoacts
1. Is any discharge observed from any part of the operation? ❑ Yes EfNo
Discharge originated at: [3]Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes WNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ! 2
Freeboard (inches): Z 3Si
05103101 Continued

is
Facility Number. 3/ -
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4fi 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 smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aoplication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
12. Crop type LO✓K , 4I [..T , >Lti
❑ Yes E:fNo
❑ Yes El No
❑ Yes Z No
❑ Yes ET'No
❑ Yes O-No
❑ Yes CJ No
❑ Yes 0To
13. Do the receiving crops differ with those designarted in the Certified Animal Waste Management Plan (CAWMP)? ❑Yes ErNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
2 No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
,-NO
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
RRe uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ETNo
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
CNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
J No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ErNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
El -No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
2,50
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ENo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
0'&0
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
El No
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
- �... - -! .,
`Comments:(refer to:q"vesnon #):-Explain agyXFS answers sad/or,any rewmmendahons or'snv othercomments._Use
drawings of facr8igto better explam situations. (use additional pages as necessary) -_ ❑ Field Coov ❑ Final Notes
I Q2 CD ✓/lS t / Lt ✓mil !ice K5 lj-a0
- ----- ._ --
Reviewer/Inspector Name r ..
Reviewer/Inspector Signature: If Dater L
O510310I X Continued

Facility Number: .71 -2od Date of Inspection I UL
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the 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?
Additional Comments and/or Drawings::
O5103101
❑Yes ONO
❑ Yes Y_I `;o
❑ Yes 27Vo
❑ Yes PJ No
❑ Yes EI�No
❑ Yes 2-No
❑Yes Ej'�No

(Type of Visit (Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 D Date of Visit:
Permitted E3 Certified 0 Conditionally Certified E3 Registered
Farm Name: ......... N q:...�..�.�.....:s. W.. �G„r,.!:`4........................................
Owner Name:.......... e.SE! . r'
....'*'I* ...........................................................................
FacilityContact:..............................................................................Title:.........................,
Mailing Address:
ional O Below
Date Last Operated or Above Threshold: ..
County:...✓P Il.`...................................
Phone No:
Phone No:
Onsite Representative: ...... le.y................................................... Integrator:.._I.:_[..v.� '!!�Ir^ ..................Y"'�5............................
Certified Operator: ................................................... ............................................................. Operator Certification Number: ....................................... _.
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Swine
Design Current
Cannrity PnmilaAnn Poultry
❑ We to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Other
Total Design Capacity C
Total SSLW C
Number of Lagoons 0 ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Ares
Iloldfng Ponds % Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. 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: ............ L.. �..........................................................................................
Freeboard (inches): 3��
S/00
❑ Yes )J�(No
❑ Yes XNo
❑ Yes ONo
nbf
❑ Yes fig No
❑ Yes gNo
❑ Yes E"No
❑ Yes ) No
Structure 6
Continued on back

acility Number: 3 1 — ZDD Date of Inspection D) Printed on: 7/21 /2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes *o
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 19 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes /Z No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes] No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ElHydraulic Overload ❑ Yes 0140
12.Crop type CorkigkI1'1ea} SoybectKS
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ElYes '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 )5No
16.
Is there a lack of adequate waste application equipment?
El Yes �No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
IV
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ,$(No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes )KrNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes YNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes S`No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes p No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes KNo
24.
Does facility require afollow-up visit by same agency?
❑ Yes No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes] No
.
. . . •{'IQt3iiUI. . (tC)IC1C_. ..S N' . . . . . . ttlFl. . i1li1S,VISIt. 1',Ult Wll� ['eCQIVI t10 t�LLl'thQl'
:•:•cories
oridence:abotitithis:visit::::::::::::::::::::::::::::::::•::•:•::
Comments,(refer to question #): Explain any YES answm ers and/or any recommendations or any other coments t
Use drawings of facility to better explain situations. (use additional `a es as neces
_p g may):: --
'47 gtipl,-C664S Are well ke fi. (aco�jmob !
•
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5/00

Facility NuDate 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
Jeryes ❑ 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 _53f4o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes ONo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes IoNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan bells, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes .KNo
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes ONo
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No

nine Q Complaint Q Follow-up of D
Facility Number 60
Date of Inspection
Time of Inspection
Permitted 13 Certified �.... C W y.......................�.Re....stered........ count Date Last Operated: ..........................
Farm Name: ��..Y..Va Conditional) Certified )n � Not Operational �`� ... .
OwnerName: ............... Phone No:.......................................................................................
rft
Facility Contact: ......34Xc.!r. )'. .F ..,..Title:...... .1..`..�c..��^r„). ................... Phone No: l �
MailingAddress: .................................................................................................................. ..................................�...z.............................................. ..........................
Onsite Representative...................�.!'��..F..4`.:�.................................... Integrator:....... !,���..............................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Latitude =• O' =• Longitude =• 01 =°
"- Design Current _ ..," ._.; - Design-- Current `. Design_ . Current_ %.:
.Swine , Capacity Population Poultry =--. Capacity Population Cattle` Capacity Population
�- ❑ Wean to Feeder ❑ Layer I ❑ Dairy
eeder [o Finish OUa ❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean `- - - - -
"❑ Farrow to Feeder ❑Other - - -
❑ Farrow to Finish Total Design Capacity
❑ Gilts,-
❑ Boars TotaF.SSLW
�Number.of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ILI Spray Field Area
HoldirigPonds / Sulid Traps E::� _ - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
Discharge originatedat: []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 10 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes bd No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes W No
AAStructure I Structure
/2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: iV2�%� V"//+-.dwy
Freeboard(inches): ........2k. I.1............................................................................................................................................................
...................... ..................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: �j — Date of Inspection
8.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
A No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
QXNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
M No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�t
MNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
O No
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN
❑ Yes
j9 No
12.
Crop type e_jlj'SG�i
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
C<No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
j No
b) Does the facility need a wettable acre determination?
XYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
10 No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes'
tR No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
MNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
R No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes jj No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes MNo
24. Does facility require a follow-up visit by same agency? ❑ Yes N No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
iVd yiolafiotis:oi• d0 icie'ndps were itofed• during 4his:visiC - You :will-t&dye do ifti they •'
cories ondence.abouEthis:visit:':':':':•:•:
Comments (refer to,question #): -Explain any, YES answers and/or any recoinmend ationsor any other comments
Use drawings of facility_ to better explain si[uaGons (use additional pages as gecessary):
10� �� \0-14S-S- cll_ 3 M i
\
& f PS (­�e-
IReviewer/Inspector Name i �')�� '` �� P�� s='.. �' `' � l `0 3 f S �3 1 Q d- �-'-- : ?G' I
Reviewer/InspectorSignature: �� 0 Date: 'Da- 99
3/23/99

a

Facility Number: -rya Date of Inspection
-
e5dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
KYes
❑ No
liquid level of lagoon or storage pond with no agitation? -
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
,9 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
ONo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
5d 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
[XNo
31. Do.the animals feed storage bins fail to have appropriate cover?
❑ Yes
KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
PLYes
❑ No
3/23/99

0 Division of Soil and Water Conservation [3 Other Agency
14 Division of Water Quality
JW Routine O Complaint p Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection1��L
Time of Inspection q: » 24 hr. (hh:mm)
0 Registered 10 Certified [3 Applied for Permit C1 Permitted 10 Not Operational Date Last Operated;
FarmName:.........5*.a! r�.......................................................................................... County':...... ....................................
Owner Name: ...............
........ ................. ..............i�t ............................................. Phone No: ... .°i.(QNj,.9j ".3e 3 ts...........................................
Facility Contact:..........�LSh .........CAW ......................... Title:....N16tlLwet.:.. ....................................
Phone No:.............:.
Mailing Address: ... �i..�...... ./ 1/.....1�ikl�......iL!.................,............................ ....... {/1�t7YS�.dJ�....'N"�...................................... Z�'3i.�.......
Onsite Representative:....;,,1p.! A......_L:10D._4]!d.......................................................... Integrator: ........ 1:!ytt ...........................................................
....
.................................................
Certified Operator; ................................. ............................. Operator Certification Number....... .._4 ..........5
Location of Farm:
Latitude
Longitude
�• �' �"
�.
Design `; Currents
Design Current - Design Current
�
Swme',',
..
Capacity
Population
Poultry,
1,Capacity Population Cattle,-' Capacfty,Population
-1
Wean to Feeder
a
-
e,
❑ Layer
I
Dairy
Feeder to Finish
1606
ILI Non -Layer
I
I -
❑ Non-Dairy
Farrow to Wean
❑ Farrow to Feeder
❑ Other
M=
❑ Farrow to Finish
`' Total Design Capacity
❑ Gilts
r 4
Total SS
7:1�
❑Boars
Subsurface Drains Present IlU Lagoon Area ICJ Spray Field Area
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
ES No
2. Is any discharge observed from any part of the operation?
❑ Yes
PD No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
P No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated flow in gaUrnin?
NNT
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
i9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
i* No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? _
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
ElYes
,0
LTNo
7/25/97 Continued on back

Facility Number: 3( - LM
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures Structures (Lapoons.HoldingPonds, Flush Pits, etc.)
Flush Pits, etc) -
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier: .............i..........................:..... ...........................................
Freeboard(ft)..........._2.............................-X............. ............................
.
10. Is seepage observed from any of the structures?
❑ Yes 14 No
❑ Yes ® No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Aoolication
❑ Yes IR No
❑ Yes 4a No
PS Yes ❑ No
❑ Yes tgNo
14. Is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............. Sickf... bt n&........................................................i4kL.........................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes NNo
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only.
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violitio.mvr defideiwks.were hoted:during this,visit. You.wil} receive ito ftiriher-.
correspondei ce about this_visit
❑Yes ®No
❑ Yes C,No
❑ Yes 0 No
❑ Yes ®No
❑ Yes ® No
[2Yes ❑ No
❑ Yes ®;No
❑ Yes 00 No
❑ Yes 10 No
>. 4.ot:, gvcABrr, sPr"1 Ey;db, %Ivad bp. FIB) pk) 4- -restceld.
�. 130-M OA-ty. ain �0�L ( don—b'kI kX01% ' l601J � tt. c.'rm. 6E"Iron orte& lob I'u"�P
trn to-5oot tt I sitouk) �e A-t U f- rtst cltd, { 1 'L' Cevr• Ir-y}��6tX tstto^^✓Id (at tJd/t.13 6 �Ipy�1.. (M-Z 6rn.LLskoA �c tt�ldpftd in-
1 6 ; � Ot: W f -C • t-6riC) S(n0"l 0 �. that1,(� iO W J rV% t t- yZEt, iOhp� dY[rCf - litctc, y�,
J�i�h S id toe ; n ��ITYv, o � Q (.� V
wr � ,
U l) CCL of Or. ex .
r. t.t .. ... - i 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: hi't. Date:

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
March 20, 1998
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Wesley Hairr
Hairr I Sow Farm
1188 VeachOs Mill Rd
Warsaw NC 28398
Farm Number: 31 - 200
Dear Wesley Hairr:
i
You are hereby notified that Hairr I Sow Farm, 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
farm 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].
Sincerely,
A. Preston Howard, Jr., P.E.
cc: Permit File (w/o encl.)
Wilmington Regional Office (w/o encl.)
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 Complaint Q Follow-up of DWQ inspection 0 Follow-up of DSWC review. O Other
Facility Number
Farm Status: [,% Registered [I Applied for Permit
❑ Certified ❑ Permitted
❑ Not Operational Date Last Operated:
[Dateof Inspection of Inspection 14:00 1 24 hr. (hh:mm)
Total Time (in fraction of hours
(ex:1.25 for 1 hr 15 min)) Spent on Review
or Inspection (includes travel and nrocessinpl
Farm Name: _....�4iLr.11..----a7t62.....�n1 .._..... ._..... �._.__.... ....__....___.... County:_/_.1lLf�Lka..____....Y....�...._._�_.._.
Land Owner Name:.. k 7 ..... _l ` ayr....._._....._......_._.... ....__...p.......... Phone No: iq �...�� ... ....�.... _.... .... _.
Facility Contact:..._ ,..._. 61G. ......... _...._...., _ Title: _1.�91Y1. ..._._.� Phone No:..�`119�
p,t_ p" p�.Z..�.
Mailing Address: ___. fa L.:�.. .....yam/ �i.... q:�.� ...._.._ _......_._._... ..... _11�k�_.n1.,.m ...... _.......amm ...... .......... ......
Onsite Representative:......_ lJ�jQ`�_.... Y__�.... ....�.... �.__. Integrator: __. j.l�
Certified Operator: ^_ t1�� q� (�. _,,, Operator Certification Number: ___i._9! 4 511
Location of Farm:
Latitude ®•���� Longitude 'lam •���<•
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes ICJ 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 Surface Water? (If yes, notify DWQ) ❑ Yes (ANo
c. If discharge is observed, what is the estimated flow in gal/tnin? NIK
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes KNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 19 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes JO No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
4/30/97 maintenance/improvement?
Continued on back

Facility Number:.. 31,,,_„ ZGb
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 Holding Ponds]
9. Is storage capacity (freeboard plus stone storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Z115, .._._3..,r.�.._.... _....._._._.. _
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?
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 ..... _...... ..__...._... _....... _...... _...................._.smrafl _.......... _.......
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?
IZ. Csvw PiPeI Tzn') �/r �otxt5
�a6ioonS st�t�tlld W N1OWJ.
low OK 6-S it-, 4, r"
4 I-&)60t, *L
( lddf. -*- $
❑ Yes Q No
❑ Yes .Z No
❑ Yes ,RNo
❑ Yes ® No
Structure 6
❑ Yes ®No
1;9 Yes ❑ No
❑ Yes PNo
■ ._
❑ Yes XNo
❑ Yes R No
❑ Yes 11 No
❑ Yes ONO
❑ Yes IANo
❑ Yes Pa No
❑ Yes P No
❑ Yes —,ANo
❑ Yes QQ No
1_41Vh Ux l k 0T torn f k
Reviewer/Inspector Name ,1 7 jam,WW� IN
Reviewer/Inspector Signature: t z / Date: _57A0A7
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

FJ
Site Requires Immediate Attention:
Facility No. 3 f _ 7-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: I -Z 1995
Time: .I Z 4' 301»
Farm
Mailing Address: FU 60X _ S9 Rcse WIT U4C56
County: D )121; n
Integrator.
Phone: 2Nq - 'Z I i 1
On Site Representative: J ri (__)0(. DO! CY r-. Phone:Gy 5
Physical Address/Locati(92g' PJD}! Z gq -C W W_C;1U Z F3
51?. r3ol, 1, 2 M P2,. - SR 13v4
Type of Operation: Swine _t/ Poultry _ Cattle 57 >w F2rm
Design Capacity: ?J' oc) Number of Animals on Site: 3�P00
DEM Certification Number: ACES, DEM Certification Number: ACNEW
Latitude: 30 ° 04- (P.47 " Longitude: 73 U 'M(AJ' 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) 8orNo Actual Freeboard: - 3 Ft. (0 Inches
• Was any seepage observed from the laQoon(s)? Yes or No Was any erosion observed? es r No
Is adequate land available for spray? Yes r N�!/o-� Is the cover crop adequate? es r No
Crop(s) being utilized: L Dr� f T(J/� 1J 0-f-MyCy of
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain..
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments: 2 is G ke �toU'1
n-P ci Ice rZ in fee7--r.r sl8;5�e s
• L-nd-o- L?tv5
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

•
•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 Z7 1995
Time: 1-U2
Farm Name/Owner: He';' re- Fes'"' S
Mailing Address: Pb 604 '259 R'
+IA i 9-2. CLA) �.
County: J ICI
Integrator: r h arm Phone:"2
On Site Representative: -3c*in Gnd- bold Phone: ZT3 30
Physical Address/Location: Ri Z &'X Z(?q- (1) e;� ;�W Za3a�
T e of Operation Swine f Poultry _ Cattle SC40 F�Prfyl
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE ✓ DEM Certification Number: ACNEW
Latitude: 3S 03 ' 1 Zr " Longitude: 01_K%ff7, 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) l9 or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Ye or No
Is adequate land available for spray? es or No ' Is the cover crop adequate? Ye or No
Crop(s) being utilized: Cori C>n% Cory.) et' m 'V_
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 or I 0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes d No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Ye r No
Additional Comments: Zr*-j-
Line L2.wr5
Inspector Name
e �_
S gnature
cc: Facility Assessment Unit
Use Attachments if Needed.