310208_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: El0 Z t;- Arrival Time: 1 Ot-19 Departure Time: I County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
T�P/-AS L,v.( I1a/)
Latitude:
Phone:
Integrator:
Certification Number: Z 6 067
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
ILayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity P.
Dairy Cow
n to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Yoo Q
Layers
Design
Ca aci_
Current
Pao P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Yes ]o NA NE
Yes
No
NA
NE
Yes
No
0 NA
NE
Ej Yes No NA NE
Yes Jo NA NE
El Yes No Ej NA NE
Page I of 3 21412015 Continued

Facili Number: I I - 19 jDate of inspection:
Waste Collection & Treatment -�%
4e-Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ �-FJYes t"o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 "" ❑ 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 I!J "n ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑'Po ❑ 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 ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes o ❑ 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 allo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes dNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E!�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
11
21. Does record keeping need improvement? If yes, check t ppropriate box belKS011
Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis alysis ❑ 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 ffNo ❑ 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: -j j�-- jDate of Inspection: O
re d-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
,E]
❑ 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
C3<o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
21 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 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?
❑ Yes0-go'
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
[]Yes
No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (reter to question #): Lxplam 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).
burr. (pa�S qo�
0, k!i so.l SfI 'Y to J• l find 4, OI"i '` LOr C�("k"�l
.i 4-0 (,e Wi5'1`c /4dlys•j 6'Vj 60 de S ef-�,rCunCLG
�9 hoys s. o1, v-
a s, �� 1.4 s o l d �f�� w'a
Reviewer/Inspector Name: 0 4 — ' (' Ih vG l
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l 1 40C q I( noy
Date: IV Z Z= C L
2/4 015

Reason for Visit_:: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I/ /'� //'j"I� Arrival Time: © Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
2 4 0 k7
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
an to Feeder
Non -La er
Dai Calf
eeder to Finish
p
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D ,ry P.oultr, +
Layers
Design
Ca aci +
Current
P,o ,
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D W 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 DW R)
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 F ❑ NA ❑NE
YesNA ❑ NE
Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Y Date of Inspection:
`Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Er7No ❑ 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 environment 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 dNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�o
❑ Yes o
❑ 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 [� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes C�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design Maps ❑ Lease Agreements ❑Ot
21. Does record keeping need ' provement? If yes, check a appropriate box bell ' . Yes ❑ No ❑ NA ❑ NE
❑ Waste Application Weekly Freeboa Waste Analysis Sod 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: -10 1K jDate of Inspection: Sl>
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EJ'No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
Eq- o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
[E]<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?
'ter to question .#):Explain any YES answers and/or any additional recorm
of facility to better explain situations (use additional paces as necessarv).
❑ Yes No ❑ NA ❑ NE
❑ Yes E5No ❑ NA ❑ NE
❑ Yes 2—'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [jNo ❑ NA
❑ Yes N ❑ NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
tv-a5�e 600� 4' 693 NN1.5 teT,,'. w-""Gti�/t'^
GLSc new �Rf4Z 4b a r(9 I-ectfCY e� dC_o�
ce OCR
S,we. � fA
�- /• � /—tt l�ct.� 1�,� G•�J l�a'itC Sa/� � .fu't���S �1��•i. ?Od:yS
�cC016 'ree/J4joq/�C.12 rq.tn�q//.
N�4E-/vR
127 ecv INcA p/--,Lc e,Yfe^sue,
1j_C 2S yoS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: V-71ULKi
Date: h.O /
21412015

.. �Division ,ofWaterQuality m,
ad1ity^NiiM6r' ,3 ,2 O-Dtviswmof Sod and Water Conservahou
Type of Visit ,compliance Inspection 0 Operation Review 0 Structure Evaluation . 0 Technical Assistance I
Reason for VisiVCJ Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 2 Arrival Time: arture Time: County: �� lam. Region: _
Farm Name: i6;jffs eyn Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: G alft?�j
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
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/6No ❑ NA ❑ NE
❑ Yes &o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Page l of 3
12128104 Continued

Facility Number: 70—T jDate of Inspection:/�..
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r I 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
Identifier:
Spillway?:
Designed Freeboard (in):
am —
Observed Freeboard (in): —h
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes F1 'No ❑ NA ❑ NE
3-=.v
❑ Yes PdNo ❑ NA ' ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the 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
rn No
❑ NA
❑ NE
maintenance or improvement?
r
Waste AAHiation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
r
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, 2 , et
.)
❑ 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
W 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
No
❑ 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
0 No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ��" No
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: L 3
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes prNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �] No ❑ NA ❑ NE
the appropriate boxes) 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues T
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any'other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
°0p Ca eJ
- l-r- yy�.
ay,a [yt Y 5 .ter, r
ao13 P'Ae-,pl
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: /L j /3
21412011

iDivision of Water Quality
Facility Numb=EMC: Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: J Arrival Time: Departure Time: io County: L�N Region:
Farm Name:J/ i{CN(y)AS (�1 COON I—r
/•}(L M Owner Email:
Owner Name: J) e 4H i • wl t—S rV./ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative:
W)
(=.xj
Integrator:
Certified Operator:_ NC -Lk
6\
wi t_! U7o'
Certificatiln Number:
n
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
]Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,ouI
Layers
Design
Ga aci
Current
P,o
D Cow
Non-Dai
Beef Stocker
its
Non-Layers
Beef Feeder
Boars
Pullets
113ecfBroodcow
Other
OtherI
Turkeys
Turkey Poults
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes I Xl No
❑ Yes ❑ No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Condnued

Facility IQnmber: '31 - Date of Ins ection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lj
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
h(l No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
❑ 7. Do any of the structures need maintenance or improvement? Yes �C I No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes KntNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) KNo
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 KNo ❑ NA
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, e c.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop (Window E] Evidence of Wind Drift Application Outside of Approved Area
12. Crop Type(s): S6 w e �(- 1 V ` 1 t-l. E�M (Z Lw
❑ NE
❑ NE
13. Soil Type(s): I LCr_— LMAJCfJ&a6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yeso
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑NA
❑ NE
acres determination?
tNo
17. Does the facility lack adequate acreage for land application?
❑ Yeso
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yeso
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
[3 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.
QWUP QChecklists QDesign ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 'KNo
❑ NA
❑ NE
❑ Waste Application Q Weekly Freeboard Q WastWast=lysis ❑ Soil Analysis
❑ Waste Transfers
Q Weather Code
Q Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and V 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 No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: C) I Date of Inspection:]
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ���``��""'''\�\��No ❑ NA ❑ 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
ist structure(s) and date of first survey indicating non-compliance: �Lo
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �iNo y❑] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No IN
XI NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
and report mortality rates that were higher than normal? 0
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
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 g I No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes fNo
o
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yeso
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Uomments (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). x
OCE qLA-Tlo S 9%i -a t"oA N045 `PEEN NNXWE . YCE04SE GC---y A Cop
cA Pta, w] Q-6 ccRbS
7o w14 lnl��GZ .vNIAAL Eon F(CLO I As
G4A)46 Soon1,4S
c�ptaC.AN -1p�cE W67E ANA S)S tgooR�s o6tA�rff2
n►A� Sc�aF �o
�,tMPr�uc; �vr N7S
w A, - JC-,r_DS L001C Coofl
(.0/ 1p
Taw oLA. C>1 l as-0EE,
Llg X '4 N� V B I I oN io ES3
P�rlu7o" oFc'V �a MwRQ 5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /(316)w' d-ic3
Date: �J f a
21412011

(Type of Visit ,CfCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit � Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: -rr Departure Time: County:
Farm Name: h mill �n__ �� — Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: %� 1 ✓� �n
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Region:
Back-up Certification Number:
Latitude: = o Q ' = « Longitude: = ° Q
a
Design
Current m �---- Design —` Current
urrent
¢Somme :Capacity.Topulatron
:; Wet Poultry P c�ityMP,>opulatior ;Catt, l,�;,;,, Capacity
Population
❑
Wean to Finish
Laver
El Dairy Cow
4—
t
❑
Wean to Feeder
° ❑ Non -Layer
" ❑Dai Calf
--
❑
Feeder to Finish
^^ W-
❑ Dairy Heifer
.
Dry Poultry -.-
'+•
❑Farrow
to Wean
❑ D Cow
Ela
Farrow to Feeder
❑Non -Dairy
x
❑
Farrow to Finish
y-❑L�
ers
❑Beef Stocker
w
❑Gilts
❑ Non -Layers
❑ Beef Feeder
El
Boars-
Pullers
Beef Brood Co
❑„❑
Turkeys
❑Turkey Poults
�..
- -
❑Other'_ ❑ Other
Number of,Structures:a-�
{
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 ONo
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes //O No
❑ YesA**No
❑ NA
❑ NE
❑ Yes q: No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
,ter
❑ Yes ,C� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ,�No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ;;'No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
ElNA
[INE
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 ZM No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes YJ 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 YJ No ❑ NA ❑ 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 qNo El NA ❑ NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground [I Heavy Metals (Cu, Zn, etc.) -/
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes TNo
❑ NA
[INE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes 4!f No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes eNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes eNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recpmmendations:or any other comments
Use drawings of facility"to better explain situationk (use additiou d'pages as neeeisiry):
Reviewer/Inspector Name
Phone: 6— rll
Reviewer/Inspector Signature:
Date:
Page 2 of 3 121.9104 / Continued

Facility Number: Date of Inspection
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 ElYes ETNo ❑ NA ❑ NE
the appropriate box. ❑ Wj IP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes allo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Z'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 2 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[:]Yes j2fNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ;!fNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes o
/
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes 'o
El NA
El NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes P'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes No
❑ NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
��,, //
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
Yes LXNo
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes L No
❑ NA
❑ NE
Additional • Comments and/or Drawings:
0
Page 3 of 3 I2,28104

Type of Visit ?--Smpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitP Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Accee y,
Date of Visit: 7,�G Arrival Time: - QQ� eparture Time: County: Region:6 /LZ G'
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �.PnLu%IJGN
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
ne No:
Integrator: ePh
lo
Operator Certification Number:
Back-up Certification Number:
Latitude: o Longitude: [�o
T
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
[]Wean to Feeder
I
ILI Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
El 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 FeMo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes_j2'iVo
❑ NA
❑ NE
❑ Yes E No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection$
Waste Collection & Treatment G /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZNO ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ` �J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes,2No ❑ 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 �ANo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes B'Nlo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 1
9. Does any part of the waste management system other than the waste structures require ❑ Yes Z No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P<o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes jl�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L2-No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
,12'No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Q�No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
L-NO
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
CI -No
❑ NA
❑ NE
Comments (refer -to question #): Explain any YES answers and/or any recommendation"i any otti comments X '_'-
Use drawings of facility to better explain situations. (use additional pages as necessary)
Reviewer/inspector Name ,� ; ._� Phone:
Reviewer/Inspector Signature: Date: 1<3O_S�-'
12/2X104 Cantinued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �2No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .QNo ❑ 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 ,INo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,ETNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ,ETNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ,-NO
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ;; Flo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes )2tNo
❑ 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 P No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ONo
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access,
Date of Visit: Arrival Time: `® jWparture Time: County: Region:''^
Farm Name: T Z /j?y Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Z /LG/✓L&-S
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:zl��
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I I--] Longitude: = o = ,
Design Current
Design C•uorent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
JLJ Non -Layer I
❑ Dai Calf
❑ Dai Heifer
❑
Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑Non-Dai
ElFarrow to Finish
❑Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El Beef Stocker
El Beef Feeder
❑Beef Brood Co
❑ Gilts
❑ Boars
Other
❑ Turkey Poults
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 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes [--]No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes XNo
❑ NA
❑ NE
❑ Yes )No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Pacility'Number:3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 gNo ❑ 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 XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P!rNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes PTNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [XNo ❑ NA ❑ NE
maintenance/improvement?
es there evidence of incorrect application? If yes, check the appropriate bo elow. El Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload El Frozen Ground avy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑Yes
J6 o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Wo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
VNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
1;yNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
U No
❑ NA
❑ NE
- ge
be
/� I% ThGmas/ Z✓%�Sar , ME'
/d/S SoA-7
f3 ere Ao d��/eases �lve
S4lG' LrIJ
UZS C-!d •�l� �d
one a cq.� i
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone:
Date:
Page 2 of 3
12128104 Continued

t
`Facility Number.
Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ETNo
❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAW MP readily available? If yes, check
❑ Yes PNo
❑ 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
Application ❑ Weekly Freeboard Waste Analysis oil Analysis ❑ Waste Transfers ❑ Annual
❑ NA ❑ NE
Certification
ep"Waste
[:]Rainfall ❑ Stocking 'Crop Yield jCa120 Minute Inspections ❑ Monthly and 1"
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes P No
❑lryN"""A ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
01yes- ❑ No
I�A ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes ❑ No
/❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
jzYes ❑ No
❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes [ No
❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA ONE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes i 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
�,,r
Ld No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
rr
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Ely� Yes
of No
(❑
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
N d GG�y f fecepil wqJ4 aAtG/y j j_f- ln.e-e_z
R/d Sail 1)t,11 'ice aoo 7 6VIA
Ali s / �� S��r�� ° d%ash s �lICA,
oti-s�� Y�ca�o�s �i/eeol door of aao��
s fle'aSc fi6, 1h1.s �a�er w a� � V/V s
Soon a t dos tl�1eIola- 3So -o2Go �L X
Page 3 of 3 12128104

C/o
U d G'v
'U — cG
i ; - G C..

0 Division of Water Quality
Facility Number 3 a d g 0 Division of Soil and Water Conservation
-- _ _ 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 111
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: O Q 7Departure Time: County:
S 011ow Tl%i��%� Owner Email:
Facility Contact: ///� J) Titl e:
Onsite Representative: � �5' 1 / 6'1"7
Certified Operator:
Back-up Operator:
Location of Farm:
we a
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Phone:
Phone No:
Integrator
Operator Certi ication Number:
Back-up Certification Number:
Region: %A
Latitude: =U =, =„ Longitude: =o=, =
Current
opulation
Wet Poultry
Design Current
Capacity Population ' Cattle
❑ Layer
❑Dai Cow
- ❑ Non -Layer
❑Dai Calf
'
Dry Poultry
_ _ _
❑Dai Heifer
—�
❑ D Cow
❑ 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?
Design Current
❑ Beef Stocker
i
❑ Beef Feeder i
❑ Beef Brood CoA 1 1
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 I of 3
❑ Yes fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
[I No
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
jEfNo
❑ NA
❑ NE
12128104 Continued

• Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ Yes
XNO
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 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 �allo
❑ 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 3 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 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
El NA ❑ NE
maintenance/improvement? �o
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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 Nyindow ❑ 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
V:�No
❑ 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 acre determination ?
❑ Yes
J2 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
2No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
0-No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. `x
Use-0rawiugsof facility to better explain situations. (use additional pages as necessary):'
fS 11
Lclgl/ G/or ue/ X o S'
/"�6i/ ..5/�lS�,�/� 7zcr�Y✓ o"G�✓ .-. vr� (�t/vs� St!�O GJ�t��
GT liGS'OU/�7 . _
IReviewer/Inspector Name A j Phone:
Reviewer/Inspector Signature: Date: 6, d
Page 2 of 1 8/0 Continued

Facility Number: — (j Date of Inspection 0 U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )2rNo ❑ 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. ZYes ❑ 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 J'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
WA fJ
SAIM6 a: s
m116-
o/12 00k a
C rap y/Q jc� �P�o�
„'es /EfNo ❑ NA ❑ NE
❑ Yes ,] No
❑ NA
❑ NE
❑ Yes 'J:rNo
❑ NA
❑ NE
❑ Yes [ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
ONE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ,❑No
❑ NA
❑ NE
❑ Yes ONo
❑ NA
❑ NE
❑ Yes O-No
❑ NA
❑ NE
❑ Yes PNo
❑ NA
❑ NE
Page 3 of 3
12128104

Type of Visit )fcompliance 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: I
11
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: ,��% Departure Time: County: Za� Regio/_Iel/�
Facility Contact: ' Title:
�
OnsiteRepresentative: 7S C✓ll$r_-
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = U = ' = « Longitude: = o = ,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes .ErNo ❑ NA ❑ NE
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
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
iE qo
❑ NA
❑ NE
❑ Yes
fj No
❑ NA
❑ NE
LD 12128104 Continued

Facility Number:3 — Date of Inspection Z�Z*
WesteAlection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes ,2Mo ❑ 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): .j C%
5.
Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1;�'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 ffNo
❑ 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 Imo' No
❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No
R
❑ 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 rE No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JaNO
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
-ETNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination.,[] Yes
ZNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
)2 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P<o
❑ NA
❑ NE
i� T-�x sorl 141110_y^r,w 9/a , 3sv - achy
Reviewer/Inspector Name ,
Reviewer/Inspector Signature:
Phone: _
Date:
12128104

Facility Number-, — Date of Inspection e
Reauired*ecords & Documents
19 Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes rR No El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Eltr Yes , No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[;(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:1 Yes , ] No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes OVo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 12No
❑ 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
ElNA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes Z'No
[:1 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 x] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ,_L2'iqo
❑ NA
❑ NE
Additional Comments and/or Drawings:
rC6rllA61277 ons
d y�as� /��Rzre� Sluff Sup v�
12128104

Type of Visit C $ Copliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit: Time: / O -0
0 Not Operational 0 Below Threshold
E3ePermitted Certified 0 Conditionally Certified 0 Registered Date Last Operated or Abov Threshold: _.
i �
Farm Name Jt{dM11S 1nt,Sa►1 YAR4/� County:
Owner Name:
?Mailing Address:
Phone No:
Facility Contact: Title: Phone No::
OnsiteRepresentative: 'R,-PtJ V TuQmAS wzuoA Integrator. MOM, - ----
Certified Operator.
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• 0' =- Longitude O• =' ="
Des ' x r:` Dmgn Current
Design Cmrmt
:Current
Swine Ca a wPo ntahon '_PAY*�_ .Ca"aa
-Poolahon..,-
C8We _
--
Ca aci .Po 6lahon
Wean to Feeder
j'' Layer
Dairy
Feeder to Finish
3000
Non -Layer
Non -Dairy
Farrow to Wean -
Farrow to Feeder
t
.
Farrow to Finish
Total Deagn"Capacttp,
Gilts
t
Boars
Total
SSL�V'
N� '.Lagoons
(
Discharges & Stream Im acts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ 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 gaVmin?
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
Id 'fi
❑ Yes /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ NN
❑ Yes
7 No
❑ Yes
No
❑ Yes
No
Structure 6
gnu er._----
Freeboard (inches):
12112103 Conthuted

Facility Number. — Date of Inspection 7 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes RrNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWt)
7. Do any of the structures need maintenancefimprovement? O Yes ❑ NNo
8. Does any part of the waste management system other than waste structures require maintenancelimpmvement? ❑ Yes R No
9. Do any stuctures lack adequate, gauged markers with requited maximum and minimum liquid level ❑ Yes ❑'l Igo
elevation markings?
Waste Aoolication --!!
10. Are there any buffers that need maintenanceftmprovement? ❑ Yes 0tvo
11. Is there evidence of over application? If yes, check the appropriate box below. [I Yes U
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type MXLLP-T 9(--t2jMu94 ( H -' & I hscucE
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 12,90
14. a) Does the facility lack adequate acreage for land application? ❑ Yes —�—N/o
b) Does the facility need a wettable acre determination? Elp Yes �N�o
c) This facility is pended for a wettable acre determination? ❑ Yeses L:INo
15. Does the receiving crop need improvement? Wes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes To
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ Yes CKO
liquid level of lagoon or storage pond with no agitation? Ea'
go
Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [�io
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [:jNo
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 El Yes LJ No
Air Quality representative immediately.
Feld Copy ❑ Final Notes
-7.) SIi"S -f fiVJuttL T(LE�S aj 8AC,4SXbE of LA&,0PA ►JALL,s, P"D c-tCA2SN6j (ctirls..W
(y(tgSS C6vEa- oo TdP of' WAWS•
IS,) PuwS 1-2� c)-11 of"60 WEED COM19-qt. BER'r'W0A 5'-6 14" umb ts"SS.
r
�jp; C(U1 l eSf / yoo�{ AecUUT6 060V C.aPY op AvNAJAL.r J? AGE s(s
( ttMUOp 4Au( n/k6 S l f3 fie GRA Ti. 6of LACKS 7463
A*�J GoP�((uUM rdE R�O6L� Gi�4RAT�t1J� d►JD fAX
Te�S��c-r" xx(fc
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Dace: 7/ 1 / 0
1L/lL/VJ lAIIAJ[(Ka

Facility Number: 3 1 _ Date of Inspection
Reriuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes N�
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes C3/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 [.
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes � 0
27. 'Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes
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? El Yes lY o-
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? �❑ Y ❑ No
35. Dces ord keeping for NPDES required forms bed impro ent? If yes, check the appropriate box below. Ld Yes ❑ No
Stocking Form [Crop Yield Form Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Additionill Coiumeats and/or Drawn - - M' ` .ffl�
12112103

,.. _ . _.._. �.:.. a _ _

IType of Visit ®.Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 19LRoutlne ()Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: E]E�0 Time:
rO Not Operational 0 Below Threshold
MPermitted Certified 13Conditionafly Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: � bht49 zd;/5 on ter' County, Olia[.'n
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: eILL2h
Certified Operator:
Location of Farm:
Phone No:
PhoneNo:
Integrator: A&,5d4e
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Oo =' = u Longitude =e 0' 0
Current
Design Current
Design Current
Ca acity P,o ulation Poultry. •
Ca aci P,o ulation Cattle Ca acity R6 ulation
Feeder ❑ La er
❑ Dairyo
Finish
❑Non -La er
-Dairyo
F7esign
Weanto
Feeder
❑ Other
Total Design Ca[laci
to Finish
_
Total SSLW
Nu�Hagoons
❑Subsurface Drains Present ❑ Lagoon Area
__ .. —_rain._ es
❑ Spray Field Area
Holding P
❑ No
Li uid Waste Mana ement System
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation? ❑ Yes [a No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
e. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PSNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: 3L_7-4M Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADDlication
❑ Yes .® No
❑ Yes V1 No
❑ Yes ® No
❑ Yes 0 No
❑ Yes J No
10.
Are there any buffers that need maintenance/improvement? -
❑ Yes
t& No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [IHydraulic Overload
ElYes
®No
12.
Crop type 4%fnmmA 67'k zc), Fe5c4e%lrkza�). tiM //
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
fA 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
RNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
RNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
®,No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Jallo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
E4 No
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
JR No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
tRNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
.3 No
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
,.�J}�,.
Comments refer to question #). Eaplain,anyTES,,answers"and/or any recommendd'ationss or+,any otherr<comments;i .: , r (✓
Use drawings: oB(acitity [o better ezplam situations (usex`additionabpages as necessary) ,, ❑ Field Copy El Fins Notes ``E
#lq �ed —1v SdmPle, 'de L;pwn on B ' z'd �EiAs, 0.4ee-
;All,V? e�t,���t w&-�
Etm hnf �� G4Ica�t41� w,ot 31i�tot /'esuI&
ND�Q• �UOQp� -�D CUT GJBe� �4- 4e, S 11�-
/,4"
Reviewer/Inspector Name
ReviewertInspector Signature: Date: /
05103101 ( 0
Continued

Facility Number. % — Date of Inspection Dom
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?
❑ Yes [&No
❑ Yes f44-40
❑ Yes WO
❑ Yes I!�vo
❑ Yes D'QNo
❑ Yes RNo
❑ Yes I L No
Additional Comments and/or.Drawings:
tie�6� neeA t ie, iln10roveP4p
�es� � '�c ✓sn �- �co�s Lnv 1� l/�iy ��,
05103101

,Division of Water Quality
> - Q Division of Soil and Water Conservation
Agency.
Type of of Visit O'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
--_�
Facility Number 3 I
20
Date of Visit:
S �S O� rime: 131 O Printed on: 7/21/2000
Q Not Operational
O Below Threshold
Permitted ❑ Certified [] Conditionally
Certified [] Registered
Date Last Operated or Above Threshold: ........................
Farm Name: .............................................
Wr..SO.......'4f�.'...`........................
��---
County:....�.._V�f
:n
0
Owner Name:.........s
..............................
Phone No:
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative:-.,o�^+asfr1��'i(.�✓t�y �,tf%�iO� g /'t✓^ c
................. ............ ........ Inte �rator:................� ..I.0 ma`s
Certified Operator: .................... .............................. ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �• �«
Design Current
Design Current Design Current
Swine .i Capacity Population
Poultry
Capacity Po elation Cattte Ca 8C1 .'Po elation
_
Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish -
❑ Non -Layer
❑ Non -Dairy
Farrow to Wean
tom'.
Farrow to Feeder
❑Other
Farrow to Finish
Total Design Capacity
Gilts
Boars
Total SSLW
Subsurface Drai
No Liquid Waste
Urseharges & Stream 1m acts \
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 I Structure 2 Structure 3 Structure 4 . Structure-5
Identifier. ........... ..
.................
Freeboard (inches):
5/00
Field Area
❑ Yes XNo
❑ Yes,2No
❑ Yes JZNo
11(A
[I Yes Z] No
❑ Yes'ONo
[]Yes j2'No
❑ Yes [allo
Structure 6
Continued on back

Facility Number: 3 I —:ZOO Date of inspection S /S O i 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 XNo
. seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
KNo
closure plan?
❑ Yes
(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 XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes .0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
/d
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ;i'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes RtNo
12. Crop type Sudotn G'.r,ss� g y e� Goas¢g I t3 eY*ti01tg / Fe5r ve Grtx ze
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONo
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 FrNo
16. Is there a lack of adequate waste application equipment?
❑ Yes.,,
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes fi No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes ONo
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes "No
21. Did the facility fail to have a actively certified operator in charge?
❑ YesXNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes XIo
(ie/ discharge, freeboard problems, over application)
❑
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'!
❑ Yes -&No
24. Does facility require a follow-up visit by same agency?
[]Yes J3`No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 'VNo
E' fQd.yiolatitiris:ot- d$ficiencies -Wig re noted during this:visit; -You will reeeiy46 ti6 further -: -: -
:-:•coriesbinideitce:aboufthisvisit:-:•:.:.:.:.:.:.:...:.:.::.:..:..........:...:::.:...:.:.:..........
I o(. Pe sure -16 use eq f /a 54e a.�t/�S, s e{ �( w;=Jr�; n 6D 4dCl75- OP
��fa(yrl-l't Y'Oct 4 Lv;l! !'lave`
x`11`4 00e f,^�o�,
/'17 So ioti. k✓I pt,! L./Ita - Yl,�ro9e>7 iS b¢i�1A SP�Ry2G1
Far;,t,47 and a/,e we// ke&-
Reviewer/Inspector Name
Reviewer/InspectorSignature: -, /// /l+pC7/,j Date: 11 •5,/O/ 5100

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

10-Routine 0 Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other -
Facility Number Date of Inspection
Time of Inspection Q 24 hr. (hh:mm)
Permitted E3 Certified E3 Conditionally Certified Q Registered 0 Not O erational (DDaate Last Operated: ...................._....
FarmName: .....a_! WS J....... ""..`So'-�................................................................. County .............JJt��'t•••..i••••_`....................................................
OwnerName: ................................................... ........................................................................ Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ..................................................................................................................... .
Onsite Representative: Q.............................................................................. Integrator:.......�k I...................................................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:/..........................................
Location of Farm:
Latitude =•=' =11 Longitude =• =' =11
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1-1 /
Freeboard (inches): .......... U�7..............
❑ Yes JN No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes 'M No
❑ Yes J�(No
❑ Yes N No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes KNo
Continued on back

'acilit Number:3t -9Gj Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? -
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there eviden of over application? ,❑ Excessive Ponding XPAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.. i.. yi.... t... deficiencies were ...:.. d;trit.. t... J s.. • .. 0 :will i eceiye tio: further.. .
cor'resporiclence aboti.it this :visit::::::::........... .
❑ Yes kNo
NfYes ❑ No
❑ Yes 9No
❑ Yes WNo
❑ Yes �<No
JYes ONo�
❑ Yes XNo
❑ Yes RNo
❑ Yes ❑ No
❑ Yes ❑ No
XYes ❑ No
❑ Yes VNo
WYes KNo @'�_
❑ Yes too
[]Yes XNo
❑ Yes D(No
❑ Yes XNo
[]Yes XNo
❑ Yes XNo
❑ Yes tR�No
❑ Yes KNo
%) S1•-��.�` o,C I-� �rlti-�13_, `\ 0. {�]�p��-��tti G�
ice. �-e `�� r1 , t— o�- 1�� �t�-h-►--�., la�gB.
\11i1� cam T dtsh> � `t troy b�-� �. - v2v\s\ cti PA r-.
Id
Reviewer/Inspector Name����,
Reviewer/Inspector Signature: �� d� Date: " 13-Qp

' Facitky Number.`3 — "O Date of Inspection tjQ
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
$tYes
❑ 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
ONO
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
4 No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
[YNo
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
�rNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
C�No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary, cover?
❑ Yes
ONO
Additional _comments and/or Urawtngs:-
.
h2we`� d
�T �v� /�T ��� 'a- �r ems,-,; IJ �' icy-/�•d (�t `�3�� a.S �
1�a�1<Q \ -- � Se�V �, O �� �'li T�Gh ,

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 31 208 Date of Inspection 7-25-99
Time of Inspection 1300 24 hr. (hb:mm)
Permitted ECertified U Conditionally Certified 0 Registered 13 Not Operational I Date Last Operated: ........................„
Farm Name: Thomaa.W.iUM.Earm................................................................................. County. D.uplin................................................ W1R0.........
OwnerName: Thomas .................................. Wilum ......................................................... Phone No: 910-26.7�1421 ..........................................................
FacilityContact: .............................................................................. Title:..........................-.................................... Phone No:.........................
Mailing Address: I27.McGmxen.Road.......................................................................... Fairion.BC ............................................................. 283.41.............
Onsite Representative: ........................................................................................................... . Integrator: MuMby.Family..Farms.....................................
Certified Operator: Rodney..G............................. W 1sim............................................_.. Operator Certification Number:.18141.............................
Location of Farm:
Latitude 35 • 04 20 Longitude 78 " • 06 30
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the,State? (If yes, notify DWQ)
❑ Yes "
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation? --
❑ Yes
0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
IR No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ................................................................................................ .
...................................................................................................................
Freeboard (inches): .................................... .................................... ................................... ...: ..
........................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (le/ trees, severe erosion,
❑ Yes
® No
seepage, etc.)
3/23/99
Continued on back

Facility Number: 31-208 Date of Inspection 7-25-99
_6: ArAhere structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ; . '
❑ Yes
H 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 maintenancefunprovement?
® Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maimenance/improvement?
❑ Yes
10 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
❑ Yes
®No
12.
Crop type
13.
�x
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?
10 Yes
❑ No
16.
Is there a lack of adequate waste application equipment? „ ,
❑ Yes
N No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
H Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
H Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
N Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
IR No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
10 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
:.
-No-violations tir:tleirciencies•were:rioied:during ttiis visit: Yoti iv�l:receive nu fvrltier:
. Mow dike walls to remove weeds and woody vegetation and then vegetate these -areas with appropriate grass cover. Vegetate bare
reas with grass cover. May want to take soil sample to help with bare areas.
4. Wettable Acres determination will be done when info is sent in.
Reviewer/Inspector Name StoaetrAHl4lsthia
Reviewer/Inspector Signature , Date:

3/7/2000
Facility Number: 31-208 Date of Inspection
Odorsuea
26.
Does the discharge pipe from the confinement building to the storage pond or,lagoon fail to discharge at/or below
® Yes
❑ No
liquid level of lagoon or storage pondwith no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
[] Yes
N No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. !broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
[] Yes
H No
31.
Do the animals feed storage bins fail to have appropriate cover? ".
❑ Yes
® No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?�
❑ Yes
® No
15. Fescue field needs weed management. Coastal fields look good.
17-18ca. Waste Management Plan, Certificate of Coverage General Permit need to be present with records.
19. Current waste analysis needs to be taken and kept onsite. Waste alaysis can be used 60 days before and 60 days after date on report
Keep IRR-2 forms updated at least on a monthly basis.
'lease send a copy of the following:
-current waste analysis report once taken (one should be taken immediately)
-Certified Animal Waste Management Plan
-Aerial Map with all fields and acreages in the waste plan
-Copies of updated IRR-2 forms for current crops
by September 1, 1999
to: Stoney Mathis
NCDENR
DWQ
127 Cardinal Drive Ext
Wilmington, NC 28405-3845
-NOD will follow
Via,

Facility Number 31 208 Date of Inspection 11-22-99
I Time of Inspection 24 hr. (hb:mm)
E Permitted M Certified E3 Conditionally Certified E3 Registered Not O erational Date Last Operated: ..........................
Farm Name: ThomAlHiken1am ................................................................................ County: DAiplin ............................................... W...IRQ .........
Owner Name: Thomas .................................. W.111011 ........................................................... Phone No: 210_26.7�J421 ..........................................................
FacilityContact: ThOMAR.W.ftil ............................................. Title: Ow.= ............. ..................................... Phone No:...................................................
Mailing Address: 12.7.AkGuwcn.Road .......................................................................... Faiiiiiii-NC ............................................................. 283.41.............
Onsite Representative: TjWMN..WjhQjM .......................................................................... . Integrator- Murphy.Familylarm .....................................
Certified Operator: RoAney..G. ............................ wilsim .............................................. ... Operator Certification Number: .18.19.1 .............................
Location of Farm:
F7r"
Latitude F-3578-19 061 -30-1
--1 OF 04 20 Longitude E
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Boars .. Tulass W., 405,000
.......... ............. I .. .....
No Liquid Waste Management System
Discbar2es & Stream impacts
1. Is any discharge observed from any part of the operation? [I Yes 0 No
Discharge originated at: El Lagoon [I Spray Field M Other
a. If discharge is observed, was the conveyance man-made? 0 Yes 0 No
b. If discharge is observed, did it reach Water of th6.S ? (If yes, notify DWQ)
*te [I Yes ®No
c. If discharge is observed, what is the estimated flowin gallium? n/a
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) C] Yes 0 No
2. Is there evidence of past discharge from any part of the operation?
Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J@ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................... ................................... .................................... ................................... ................................... ...................................
Freeboard(inches): ............... 20 ............... .................................... ................................... ........................... ........ .................................... ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, C] Yes 0 No
seepage, etc.)
3/23/99 Continued on back

Facility N jumber: 31-208 Date of Inspection
11-22-99
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
N 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
® No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
N No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
N No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11.
Is there evidence of over application? ❑ Excessive Ponding N PAN
N Yes
❑ No
12.
Crop type Coastal Bermuda (Graze) Small Grain Overseed Fescue (Graze) Sudan Grass / Rye
13.
Do the receiving crops differ with those designated in the Certified Animal* Waste Management Plan (CAWMP)?
❑ Yes
N 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?
N Yes
❑ No
16.
Is there a lack of adequate waste application equipment? N.
❑ Yes
N No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
N Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(id WUP, checklists, design, maps, etc.)
❑ Yes
N No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
N Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
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?
N Yes
❑ No
4'N& Y' iolaiib6i tir.dfeyiiericiei'iveie.rioied.dui'ing itiii'iWE Yriri ivff riieive.no fiift ier . -.
.'rnr.�ucririoHivirw'�Ivi�it'thik. ......'.'.'.'.' .'.. . . . . . . . . . . . . . . .
1- Over -Application was noted on millet by 50 lbs. Nitrogen. Need to reduce PAN rate on Rye Cover Crop 200 lbs. nitrogen - 50 lbs.
ver-applied = 150 lbs. Nitrogen to rye..,
5- Need to replant fescue behind lagoon next spring or fall.
7- Need a copy of Certificate of Coverage and General Permit For Swine Operation with paperwork on farm site.
9- Need to start keeping weekly freeboard levels of lagoon with paperwork. General Permit Requirement.
5- Need to have Waste Plan revised to include coastal bermuda acreage into Waste Plan behind lagoon.
tote: Soil samples have been sent to Raleigh but results were not back at time of review. Need to contact Stoney Matthis in regards to
gettable acreage determination at 910-395-3900.
Reviewer/InspeMorName "��crott'gttluth
... :: ..
Reviewer/Inspector Signature. Date:

317P2000
Facility�Number: 31-208 Date of Inspection F 11-22-99
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?Y.
,>
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ® No
FEIN Eff-
❑ Yes ® No
❑ Yes H No
❑ Yes ❑ No
Need to contact Duplin Soil and Water by Dec. 01, 1999 in regards to amendment of Waste Plan to 200 lbs. of nitrogen to small
Need to mail swine integrator registration card to farmer.
i f, h ,.
�i

V—/z
0 Division of Soil and Water Conservation Operation Review
Division of Soiland Water Conservation Compliance Inspection .t
12 Division of Water Quality:Compliance Inspection r -
0 Other Agency jOperation Review Y
P Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other 1
Facility Number 3 Date of Inspection
Time of Inspection ,300 24 hr. (hh:mm)
Iff Permitted 0 Certified 13 Conditionally Certified E3 Registered Not O era[ional Date Last Operated:
Farm Name: _Th D n4ol $ '�`� , I � Cl �"n County ..... �' '�
50
v
�—Th e . 4s
Owner Name: .......... ._....../... I f S O ✓� Phone No: .......................
1/�1....................................................................
FacilityContact: ............................................................................ Title:................................................................ Phone No:...................................................
':Flailing Address: ..........._..�........r...—............................
............................................................................... . ................................................�.............�......)...
................................ .....................................
Onsite Representative: ...... w......
/...S..01
..................................... Integrator: ...... Y f/
.............. . ........ ................ ..
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =•=' =•• Longitude =• =' 0.:
- - Design Current = - .>.. Design,, Current' Design Current
Swine: .:.. Capacity Population Capacity -
PopulationCa acity Po Population Cattle
❑ Wean to Feeder ❑ Layer - ❑ Dairy
Feeder to Finish J❑ Non -Layer I ❑ Non -Dairy
[]Farrow to Wean
❑ Farrow to Feeder ❑Other
'[]Farrow to Finish Total Design Capacity
❑ Gilts,
': ❑ Boars - Total SSLW
Number of Lagoons _ ; ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding'Ponds-/Solid-Traps m ; ❑ No Liquid Waste Management System
DischaMes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
It. 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 CK 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 24No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .................... ............................................................................................................................................................. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes El No
seepage, etc.)
3/23/99 Continued on back

a
x
X
Ft�
x
'Y,
k

lFaeffity Number: 3l — 2 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence — of over application? ❑ Excessive Ponding ❑ PAN )
12. Crop type res culler Oel,&LvdcC Sv tnwLe-r /lit/, ✓L'�`e' yr Ann oz
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components.of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes (9 No
R Yes ❑ No
❑ Yes ® No
❑ Yes 5ff No
❑ Yes igNo
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
IN Yes ❑ No
❑ Yes ® No
® Yes ❑ No
® Yes ❑ No
NJ Yes ❑ No
❑ Yes ® No
[]Yes ® No
❑ Yes ® No
❑ Yes JZ No
❑ Yes ® No
[]Yes JE No
0' d' •yiolatiotis:or• d, f&' 1encles were itofedd'&' ing th,is:visit: Yoit will i eceipe Rio fuith$r
correspondeirce. about. this visit.
Comments (refer to question #)t . Explain any YES. answers and/orauy'recommendations or any'other comments ',
Use drawings of facility,to better explain'situations. (use additional pages as.necessary):-
I Mew d;ke walls fo reMv✓e weeWs � �ooQ ve e14R , %7 1,4
then ve�efor}e these great w;IG, Rppfo�o,�;y��e "a.qJ-0Ver.
Ue �i bete grea5 W1 amass v_r, A?01L tvm- ,
14. Lvef>,_ :�r • s �o-l-eeP711?igh' `, w; 11 be dope Whew ivl/a
hr Se n -b P) -
Reviewer/Inspector Name �� Opig ,W4��:..4 a.S - - _
Reviewer/Inspector Signature: � Date:
9l o) 3 y5` 3 q Db � e,*L • �2 3/23/99

Facility Number:
Odor Issues
Date of Inspection
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?
C9 Yes ❑ No
❑ Yes ]K No
❑ Yes M No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes IR No
'Additional ommentsan or_. rawings: , " .' _. . ` - - - ' r _ _ I - -
15. �eSGVe �';e1G{ �JeP.ds t.�eQ m9n�y�nl.e''t'%". CQGs-I-yl.��elds
lco�C Qcod ,
1?-IPGA(n/✓gsYYflRV14�Jte�'le�l�-Plan, Cer�;�ic1rzze � Cave�� e�
G'e ae/ Q� rey-Y14 T llep� 4, 6e 121 esen I W/ y ecGa�&i
M. c urrcyi4 wci--' e �nyl ys s needs 4e ,fie f4,Eetn and ke f4
On 514e - L✓q!4e cein be UseG GO dti S before
5 ydele y
AY14 60 day ��Q✓ o)n_ re f'ar�,
reed' I-R9- ZI
- �o,^rns v CJImd( Q). lefty' on Ci ►kol4-jiJ
� 1 G�asc ser p1 Co of Ae f ollaw�n
�y 9'
" Cvr✓e�� 1.i�fSFe c�n9%yf�s ra o� mnce Ake, one should
C e r t i eGt /t n, ✓4,3 j�q s-ke 9� e �t4M ed;,dd
ens / 141, i
Aet^iN) M'qP ItJ/ �jll Y)e/d5 clod 'qC'ceqt:s ���
1�e waste FJan
f_
Cedes o� Ufdst4ed ZeV-44�'-Z-Cority- 4/' cul'Pe'7T
G>^o�4S
Iviq�-1� 's
IN
Ewa
12,E G�i/'Of %nh� �eive GX' �
Ak- 2F*0s- 3g4-S
lU oD w; ll-�olloW
_
3/23/99

X
L

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
3 0 Date of Inspection I (Q/ G
Facility Number
Time of Inspection UZLIO—i 24 hr.
13 Registered 1 Certified [3 Applied for Permit E3 Permitted 13 Not Operational ]� Date Last Operated- --------------------------
Farm Name: l I6A!A:5......... jf.i.15eh....... f un..!':............................................ County:.........lJ.!!�l�ii:)...........................................................
................./�
Owner Name: ..................
.............. ...... IL)K I _a'c (I .............................................. Phone No:.._L�.�Q�..Z �. i..�. J.U......................................
FacilityContact: ................................... :.................... ..................... Title:................................................................ Phone No:.....................................................
Mailing Address:...... 21..... /.V.iL.L-OMt..... 9tt'........ :......1fri.S�.^....f..Nv............................................ .........
Onsite Representative:.........1"6......... UAs.4h................................................. Integrator: ....... M.V.. {1�..........................................................
Certified Operator..............................................................................:................................. Operator Certification Number,.........................................
Location of Farm:
Latitude Longitude
Design Current: Design „Current Design- ` Current' °
Wean to Feeder -- LJ Layer LJ Dairy
Feeder to Finish pip ` ❑ Non -Layer ❑Non-D
Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish - ' Total'Desigo Capaci
Gilts
Boars Y Total SSLI
No Liquid Waste
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in ;al/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes kNo
❑ Yes P No
❑ Yes `t' No
❑�Yes
.t W NNoo
1
❑ Yes [P No
❑ Yes 1P No
❑ Yes No
❑ Yes No
❑ Yes qNo
❑ Yes 9No
Continued //on back

Facility Number: .-SI — 2_08
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes (f No
Structures (La2oons,11olding Ponds. Flush Pits, etc.1
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(ft):..........,'................ .................................... ................................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes �) No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers'? -
;❑ Yes
OLNo
Waste
Application
14.
Is'there physical evidence of over application'?
-❑ Yes
O.No'
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15.
Crop type...............]Derm,dA8,................<, lik..... ( n............ V P c t- ............ ..:5.� r� .Os ..............................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
❑ Yes
;QNo
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
V Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
(59 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
/)�
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
Yes
❑ No
0
No violations or deficiencies were noted during this visit .You will receive no further
correspondence about this visit..'
J arawmgs, of facility to better explain situations. (use aaatttonai pages as
z v� ct�ci s ova 1& �• �(K� wall S�o�d be rW�e�nkfJ
t�_iror CTJiccx 'O,. of Rl frb�u_ , < 2s1bSAI,-
7/25/97

(0-Routine 0 Complaint 0 Follow-up of DWQ ins ection 0 Follow-up of DSWC review 0 Other
I Facility Number Q
Farm Status: ❑ Registered ❑ Applied for Permit
® Certified ❑ Permitted
❑ Not Operational Date Last Operated:
Farm Name: _n.ua s�...L44�sr s ^....__..... ....... _...... , County: ..aF1r.�xat......... _..............
Land Owner Name:..SJn o,,a u3....... y.,.L..9......... ..... _..... :_............... Phone
Facility Conctact
Title:
Phone No:
Mailing Address:_.�1...._MS� 4�n1.? ....�e.0 sl _....__...._._...._....... _ SLsS.O.'!.r.—tJ .—...._.... ....__.... 24-3.-q...I..
OnsiteRepresentative: V..-V.ta....Integrator: _j�J�,1_C���..—.... _...... __.... .T......
_..___.
Certified Operator: _{to �i i IS71i....__....__.... ....__.... .. Operator Certification Number:-J11.1i.................... _...
Location of Farm:
Latitude ©•® 20 Longitude =OF06 36«
I ype of Operation and Design CapacityY"DesignCurrent �DesgiilCurent� tDesi n Current"
;Swine a �®Ca aci :Po ulationr , Poultry Ca acitvEPo' ulahon =Cattle g _ Ca iigit`. Po ulatio
❑ Wean to Feeder �_�❑ Layer ❑ D
® Feeder to Finish 3 oo o ; -= ❑ Non -Layer , ❑Non-Da'ry
Farrow to Wean,10
Y €
El Farrow to Feeder Total Design Capacity ooV
Farrow to Finish
,10
'
Total SSLW 4os <�
Number of}Lagoons / Holding Ponds 0 R ❑ Subsurface Drains Present
IV p
Nw ❑ Spray Field Area
t ¢ ❑ La non Area p y
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes EffNo
■ �i
❑ Yes
01No
❑ Yes
2,No
NIA
❑ Yes
No
❑ Yes
® No
❑ Yes
gNo
® Yes
❑ No
Continued on back

Facility Number:....... —.'Qg
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
9j No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
gNo
Structures (La-oons and/or Holdino Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
kNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
®Nro
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
RNo
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
Ej No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
IQ No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
rye
Crop type S.x. (.... _tFrmSi..... _..b-cli:mrda ..�...� eu..s ...._...._`$� ..._
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
14 Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
B No
18.
Does the receiving crop need improvement?
1K Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
JS No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
1KNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
For
Certified Facilities Only -
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
24.
Does record keeping need improvement?
.Q Yes
❑ No
u�c maw,ngs or iaciury to oener explain situations (use additional pages as necessary)
S• F, I t t h t• V_T : i e to p' P I }Y'C wC t%. N L t I� S vv�a l l b A- ✓v oo v-0 v v4 ,.
IoE���a�v.lF1f
Q
►� a
a
;r
Qk-ej # y
Z. O a de-br,S of �ayoor yvall• vReve
4-to-
t� bare. •Stofi
aK I�r9ooh
`J
�J
IQ. WorK- 0r we-e-�+v -ds iUbe,rwvokm
l6. Get loL. ` iti �it.Lk #L) p�� iv fa
Plo ..
A-S0j 3Qt
pro-
V
e E S v a aM ) ra LS ` c-P_ l `J P v I' i — i-o
F l.p.,...
`{ • Got c v r v' *-- tt s o � 1 ?S
t a r-e'
• 1 v.. u-tLOl ,
1- e LAY w- a
S v r f. +-v-o- t. t 44 C 4l wv ru b -e�✓i o w
S p
y- a LO r-j_c
c-o rr e_t P O
- -: l-t- ._.. -t-- - - -'-
_
Reviewer/Inspector Name Lei j g
Reviewer/Inspector Signature:
cc: Division of Water Quality, Water Oualitv Section. Facilitv Assessment
Date:

Z Site Requires Immediate Attention: n
�g4 Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:'% - X 7 1995
Time: / A ; 3
Farm Name/Owner:- A,,
Mailing Address:
County:
Integrator. Phone:
On Site Representative: Wx th r%lone:
Physical Address/Location: Eta 5, f l r / /_Cr
Type of Operation: Swine ✓ Poultry _ Cattle _ T / n r5aln�s
Design Capacity: 7) -:? 2�"b Number of Animals on Site: 3-? S D
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 E * Dom- _' 1-5 ^ Longitude: -7 V` ' a( " 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)(!gor No Actual Freeboard: 9- Ft. C Inches
• Was any seepage observed from the lagoon(s)? Yes o o Was any erosion observed?. Yes or(S
Is adequate land available for spray? Yes or No Is the cover crop adequate? 0or No
Crop(s) being utilized: +-,Q 4— Qo
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings` 5s or No
100 Feet from Wells? 6 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or&l
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes ore
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 00 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)? e No
Additional Comments: -2- 4�' 10 t
r q
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.