310212_INSPECTIONS_20171231

2
NORTH CAROLINA
Department of Environmental Qual

Date of Visit: / / Arrival Time: j n Departure Time: / County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �/Y/"� M t e`-Gl-t 6 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: / 71 J ir-
Certification Number:
Longitude:
Swine
W [o sh
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
can [o Feeder
O
6-00 I
lNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to can
Farrow to Feeder
Farrow to Finish
D , P,oulh, �
Layers
Design
Ca aci
Current
Pao P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
lBeefBroodCow
Q[her
El Other
I I
=Other
Turkeys
TurkeyPoults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes D-1 �01__] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
i
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Nuprber. - 2/ Z 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
S&
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ffNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes El"No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑- 50 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 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
© N _
❑ 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
[�o❑
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�--����
L - 0 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
❑ No
U NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ 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: 3- 21 L Date of Ins ection: / /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ffNo
w❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes afNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ErNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No OINA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[—]Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No
�o
EfNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. '
Iisedrawinasnf facilitvto-Netter exnlainsituations (use additional naves necessarv)."-� •- �.; - -� '
Reviewer/Inspector Name: v 1 (ter /�( �D >1 t l^ 4 Z Phone: ��� 7Y 6 7.3 vt
Reviewer/Inspector Signature: Date:
Page 3 of 3 21417015

Reason for Visit: Z) Routine 0 Complaint 0 Follow-up O Referral O Emergency Q Other 0 Denied Access
Date of Visit: 5 Arrival Time: � Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: �p�t�j- (✓l-r-�[_(.J[;j,(� Integrator:
Certification Number: 1CIq $ f
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
[-]Yes EINo ❑ NA []NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes [-]We ❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Ins ection:
Waste Collection & Treatment
`4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Strucct_ure, 22 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f %� % /'q&Mty
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 13 �7_
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 ZNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen al 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 YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ 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?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Required Records & Documents
Z)�o
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Dods record keeping need improvement? If yes, check the appropriate box below. des [—]No [:]NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall In! 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6 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 21412015 Continued

Facility Number: Date of Inspection,-.�Z24'jlu
-24.
Did the facility fail to calibrate waste application equipment as required by the permi ?
❑ 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.
❑ 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
❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
!Ail
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
"o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30.
Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
VNo ❑ 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?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
6r?N
❑NA ❑NE
o❑ NA ❑ NE
(Comments (refer to question 9): Explain any YES answers and/or any aaatttonal recommendations or any other comments. I Use drawings of facility to better explain situations (use additional pages as necessary). ,
o,) gC - p5��
a �tfWV6 � Fay l�d0s�A 1
sort AnK6
Reviewer/Inspector Name:
90'n/ rl/owjiJ(Jj (.dwC'12- Z64iG L wLf
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

(Type of Visit: ID Cogfpliance Inspection U Operation Review U Structure Evaluation O Technical Assistance I
Reason for Visiti CJ Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other t�� �Denied Access
Date of Visit: �(p/li/)j Arrival Time: ® Departure Time: County: �IA�IV Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 0 6T U4C-1 1 ,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: �jg/'
Certification Number: rCu
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
11-ayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle C5pacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dty P�oultn
Layers
Design
C_a aci.
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes n Teo
❑ Yes ©% o
❑ Yes Yo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facili: , Number: - Date of Ins ection:
,�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Identifier: (, , l LA&,W �-
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
CXNo ❑ 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 environrnento threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes LQ `Y V ❑ 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 ow. �es No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? rj j'es No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ NN9oo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes W;o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [ N ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ 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

Facili Number: jDate of Inspection: l l /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes —�(J(
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes INo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [XNI ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes IT;KNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes N ❑ 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 d' ❑ 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 Z ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes WNo ❑ 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).
rb:) NVZO) Zn L-z✓eL— A13a✓C- 3060, 'b
AAD/t6,Sf TSS��. CavM'iv Ac�oNUM�57� Mtn, AS�s�,gNcE
Reviewer/Inspector Name: ✓O�d —6vi Eu- Phone:(Q10 '26
Reviewer/Inspector Signature: Date: &1 11 )
Page 3 of 3 21412015

Type of Visit: aCom once Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other 0
Denied Access
Date of Visit: Arrival Time: ® Departure Time: ,1 I County: D L�CG�►�/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: �7 Title:
Onsite Representative: 1 (L�� �(-�i (_! \ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I q q b b
Certification Number:
Longitude:
Swine
Wean to Finish
Design Gu6ent
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P.
Da' Cow
Wean to Feeder
QQ
Non -La er
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,o_ul
Layers
Design
Ca aci +
Current
P,o P.
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El Other
—TurkeyPoults
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes U 01 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Pagel of 21412011 Continued

Facili Number: - Date of Ius ecfion:
Waste Collection & Treatment
4;'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:AL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes C24o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental real, 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 ❑ o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 940 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes NA ❑ NE
v
mam[enance or mprovemen[.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Vo ❑ 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
❑Xo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Io
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2,N—o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ea<o
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B No ❑ NA ❑ NE
❑ Waste Application El Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [rNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 6 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection, /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
VN
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
I__I No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes VIVO ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Ea
❑ NA
❑ NE
ED_No
❑ NA
❑ NE
V[.� N
No
❑ NA
❑ NA
❑ NE
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments: I
Use drawings of facility to better explain situations (use additional pages as necessary).
�rcw �wR1��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
jL6w wup
Date:
7
-1371

Reason for Visit: QfRoutine O Complaint O Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: pof LQ� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: F(i,( lL/I I l �
Certified Operator:
Title:
Phone:
Integrator•
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to FinishI
Design Current
Capacity Pop.
,et Poultry
JLayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
1{
Wean to FeederI
INon-Layer
IDai
Calf
Feeder to Finish
Farrow to Wean
Dr, + P,pult . +
Layers
Design
Ca aci
Current
P,o
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Ed/No
[-]Yes [—]No
[-]Yes ❑ No
❑ Yes n jVo
❑ Yes VNoYes
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: Date of Inspection: I$
Waste Collection & Treatment
4. s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier: LkandL 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes d No ❑ NA ❑ NE
❑ Yes EZ/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNdo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes © No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes � ❑ ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes Zo NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 2 Nye ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
,
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[:]Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ 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

Facili Number: 31 - 2 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the pectin 1, Yes ❑ NA ❑ NE
25'Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes YNoo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes No ❑ NA ❑ NE
Other Issues
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 � ❑ 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 Zo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: /
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes U N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. ,
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: Phone((/ i.t7 �3O)
Reviewer/Inspector Signature: Date: S 1
Page 3 of 3 2,42011

Type of Visit: Q Cooptpliance Inspection p Operation Review O Structure Evaluation C) Technical Assistance
Reason for Visit: � Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: '(/ Arrival Time: Departure Time: County: D UP Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: SWASTtj Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I1 1 8 D
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
Ut)
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P.
DairyCow
DairyCalf
Feeder to Finish
Farrow to Wean
Dr Poultry
Layers
Design
Ca acI
C•urreot
P,o ,
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
IBeef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Yes 2No 0 NA NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
No
NA
0 NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes zo ❑ NA ❑ NE
❑ Yes [NNo 0 NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection: 53
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: (ACeiro01 i-A&M34 7/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
32
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 EZ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
t ?
ma m enance or rmprovement
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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
Q 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
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
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a min 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 21412011 Continued

Facill Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C] o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [NNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ 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
C 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
0 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
C� 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
d] No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E�No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
k�
GC--. caPY
Reviewer/Inspector Name:
01C CALT-bm-u .a✓
Reviewer/Inspector Signature:
Page 3 of 3
fqtj 1 A't'k L'- Phone — 3 D f
Date: g Z
1/4/2011

Division of Water"Quality
IePFqT `a^� %., .QQDty ision of Sotl and Water Conservation
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: // S County:
Owner Email:
Facility Contact: p Title:
Onsite Representative: rE-6L Rai Vyn1?�0
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: Mc[MM-1,[­] Longitude: [MM—]cM, M
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 N 0 NA ❑ NE
[I Yes No ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: — a Date of Inspection II
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: Lyp� Gcm,'i tA&-tzn.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): yt-( 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes o
❑ NA
❑ NE
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr/eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes IYY,ro ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes No, El NA [I 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 L7 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ;Z'No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ,
18. Is there a lack of properly operating waste application equipment?
❑ Yes 13'No
❑ Yes R No
Comments'(refer to question ft Explain any YES answers and/or any recontmendationror any oilier comments
Use drawings of facility to better explain situations. (use additional pages as necessary). -
[I NA [I NE
El NA El NE
Reviewer/Inspector Name G N. j� f (�ftl -.:( r. ' -I Phone: L _ �
Reviewer/Inspector Signature: 9 Date: .S
,.F z s 12128104 Continued

nA
Facility Number: .5 1 —oki Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
El
NNoo El NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
L o- ❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
/
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ElYes
U,"o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V N``o ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
[P.IVo ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E31 o ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�bto ❑ 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
o ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes2No
,,��,,//
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑'No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo ❑ 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
2rNo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�Z ❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ()JC pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit: Rt&jeb Arrival Time: ® Departure Time: County: O Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: J Title:
Onsite Representative: Fenst- 1 S M=+{ - Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: O o r --- 1.
M Longitude: [----j° r ---- 1,
_ - Destgn ..Current ., -.Destgn Current y,4'^,�,. Designer,
Swore C#pacityy'Populat�on Wet Popltry Capacttyw Popul ition „ Cettle Capacity
e
C`ul•rent
Population
''
❑ Wean to Finish
❑ Layer
❑ DairyCow
«.
® Wean to Feeder
(o QW
❑ Non -Laver
-
❑ Dairy Calf
=��
❑Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars`.
Other
❑Other
j
6" ., `�"^`,,, �'
'"'*-"""'^,„,-
" ❑ Layers
❑Non -Layers
❑ Pullets
❑ Turkeys
`- ❑ Turkey Points
❑ Other
❑ Dairy Heifer
t. ❑ Dry Cow
90 Non -Dairy
-'- ❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
„" "'•�.r"'",',"�•
.�`. Nube oftStructures:
-
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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
o
❑ NA
❑ NE
❑ Yes
TNo
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number•. —�
Date of Inspection !a
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?
Sttruc�to e l Strru�ctu�r�/ 2 Structure 3 Structure 4
Identifier: (.i41 � (A'�"—" L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ _ 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes 7No
—/ ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,.,
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1_}'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application 7No
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesEl NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑NA El NE
nNo ❑ NA ❑ NE
.�K/ o❑ NA El NE
ld o ❑ NA ❑ NE
No El NA El NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments r v
Use drawings of facility to' better explain situations. use additional` pages as uecessa
IReviewer/Inspector Name I -,:. r- 'I Phone(_`it' /'76 --)3ryI
Reviewer/Inspector Signature: Date: /O
Page 2 of 1

Facility Number: ) — Date of Inspection
Required
l l
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
ElYes
No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E& ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ElL/I Yes
_
No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑Yes
LJ �Io ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,_.., N0 ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes 1� No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required b the permit? El �No ❑ NA ❑ NE
tY g Y q Y P
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
��YN
ENO
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑eNlo
❑ NA
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L—✓JJ�
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑yes
LJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V
❑ NA
❑ NE
(Additional Comments and/or Drawings:
Page 3 of 3 12128104

IType of Visit (25 Cmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit l'J Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: IS 109 1 Arrival Time: / o Departure Time: County: QV Region:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: < Title:
Onsite Representative: pe'w
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' Longitude: a o = ,
Design
Current
Design Current
Design Current
ine
Capacity
Population
Wet Poultry Capacity Population
Cattle
Capacity Population
El Wean to Finish
^ ❑ Layer
❑ DairyCow
Wean to Feeder
U0
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
❑ DairyHeifer
Farrow to Wean
!Gilts
Dry Poultry
La ers
❑ D Cow
❑ Non -Dairy
Farrow to Feeder
Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other.
❑ Turkey Poults
❑ 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 6No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑(j10
❑ Yes
LJ No
❑ NA
❑ NE
❑ Yes E No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — j Date of Inspection ag
i
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: (.ii (VD N l (<X� N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ElYes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes F,1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [�`No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 L1I No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes o
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes No
� 17. Does the facility lack adequate acreage for land application? El Yes {{{[No
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No
/JP4,rC % SG 0 /1FWId/AL
Rea -tire r 062044" aY
LE
PftA-Y F")r 4 6&Z-O /3atto,
❑ NA ❑ NE
❑NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA El NE
IReviewer/Inspector Name I 6 N.. f !2 L I Phone — /3 I
Reviewer/Inspector Signature: Date: / j 0

,Facility Number: —
Date of Inspection JS U
11eguired
Records & Documents
/
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
Jo
❑ NA
El NE
20.
Does the facility fail to have all components of the CA W MP readily available? If yes, check
❑yes
7No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
,_,(/
E J 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
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,dNo
lJ
o
❑ NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,20
L�J/No
❑ NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
ElLI Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues �/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ICJ No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ 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?
El Yes
,�{/
LJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
— /o
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Z4
I
Type of Visit Q Co fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: FIR 3 b Departure Time: County:_ Region:
Owner Email:
Phone:
Facility Contact: n Title:
Onsite Representative: 6rG W44 P�ijj Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = « Longitude: = ° = ' =
a
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
JEI Layer I
❑ Dairy Cow
Wean to Feeder
JLJ Non -Layer I
❑ Dairy Calf
Lj Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
❑ Non -Dairy
ElFFarrowLaersow to Finish
❑
El Beef Stocker
Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Co
El Turkeys
Other
❑ Turkey Poults
❑ 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 nNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
El No
El Yes
L YNo
❑ NA
❑ NE
❑ Yes
♦d No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — U
Date of Inspection
'r 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?
�,n
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 64 Ooej� CA6-cyl % I/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q 3 14 T
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E2N0❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0NNo ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes rfNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes <o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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
El No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
2Noo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Commentsa(refer to4�,quespon #) �Ezplam any�,YES aoswe�s�and/or�anyHrecommendahonsdor any�othercomments`�'�
�Use drawmgsµoffaethty#o better explain s taattons (use addrhonal,�pages�as#neciewss�ary) .
t.*��. aZ.�sr`.hss`5..-Yv�vv�
a
Reviewer/Inspector Name C J—,t*JPhone: i - 6
Reviewer/Inspector Signature: Date: 1 6
Pape 2 of 3 12128104 Continued

Facility Number: 3 — Z Date of Inspection
Required Records & Documents ' ( ,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (_{No El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ Yes
❑ Yes
❑s
YeYs
❑ Yes
No ❑ NA El NE
No ❑ NA ❑ NE
®N ❑NA ❑NE
I o El NA ❑NE
El Ntf/ ❑ NA
No ❑ NA
❑ Yes
QNo
❑ NA
❑ Yes
dNo
❑ NA
�o
❑ Yes
❑ NA
El Yes
No
❑ NA
❑ Yes
Z No
❑ NA
❑ Yes
plfIo
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Page 3 of 3 /2/2 V09

facility Number
C1 Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit Grecimpliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
t Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 3 3" of Arrival Time: /l.ca Departure Time: County: DL4 C W Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: CZGnatG PCTrur
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
aoD ❑ Non -Layer
Dry Poultry
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes -dNO ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes [/No ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 — Date of Inspection 3a
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
ElYes 2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 196-o°N I L4 r-y / Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): el S'/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes L'J 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 ❑ o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
IQ NNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E3 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
2(No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E4o
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Rl 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 Mo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Ao
❑ NA
El NE
17. Does the facility lack adequate acreage for land application? ElI[J Yes
,[
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
V No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName '-I-j Phone: / C/ - 3 g AV
Reviewer/Inspector Signature: Date: d 3c o
12128104 Continued

FAcility Number: � Date of Inspection 3• o�
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
I�jr.>
El NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
Elyes
No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Io
❑ 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
EfNo
❑ 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
IQ NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L'J NNo
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
2 No
❑❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E NA
❑ NE
Other Issues �,�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes to No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;I -No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ Flo
❑ 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
�TNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
ONo
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
e/No
❑ NA
❑ NE
Comments and/or
12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
—" 0 Other Agency
rype of Visit
Co Hance Inspection
0 Operation Review 0 Structure Evaluation
O Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up 0 Referral Q Emergency
O Other ❑ Denied Access
Date of Visit: I (oSL) 0(. Arrival Time: Departure Time: a.3o County: 11 UPL JV Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: k CR.C6 '19f. DuS
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o = ' = Longitude: C
Design Current - Design Current Desi
Swine Capacity Population - Wet Poultry Capacity Population Cattle Caps
Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of
Discharges & 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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
0
n
❑ Yes O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility`Number: _I — Date of Inspection a uy
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA 60wV ) LA boom' —
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7 S 34
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes JJ No ❑ NA FINE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ZNo ❑ NA ❑ NE
ElYes C No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,_,(/
9. Does any part of the waste management system other than the waste structures require ❑ Yes L�J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,{/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �C.J No ❑ NA ❑ NE
maintenance/improvement? ,(/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Y� 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(Hi) S % d
13. Soil type(s)
l-f
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LJ No
❑ NA
❑ NE
❑
❑ NA
❑ NE
//!o
O o
ElNA
❑ NE
L_dK
❑ NA
❑ NE
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I �TZ>NIJ t-AeAA6 Lk, I Phone: (111V 756 - 135��
Reviewer/Inspector Signature: 4,re . Date: 6 b-7/a.
e--

Facility Number: 3 ] — 'f� Date of Inspection
Required Records & Documents {
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t No El 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 [I Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�(No
❑ NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
k<O
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,
L] No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LJ No
❑]NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[I Yes
❑ No
E: NA
❑ NE
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:
❑ Yes �[-Io ❑ NA El NE
ElL�1 Yes No ❑ NA ❑ NE
❑ Yes EKo ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
El Yes �ry
❑ Yes CJ No
❑ NA ❑ NE
❑NA ❑NE
Page 3 of 3 12128104

Type of Visit X Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ; Departure Time: ° County:'-. Region: r'`O
Farm Name: /� ✓ Owner Email:
Owner Name: / 'tf�A L�%L S Phone:
Mailing Address:
Physical Address:
Facility Contact: %/�! �Title:
Onsite Representative: e '. 4 TQ 'e F—%TLl S
Certified Operator: :111.4 `W C/f-
Back-up Operator:
Location of Farm:
Swine
Wean I
Wean t
Feeder
IIFrvMe .
Other
❑ Other
Phone No:
Integrator: �YF�G05B/P'V
Operator Certification Number:
Back-up Certification Number:
Latitude: = U = ' = Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
(p OD I Q I ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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?
Design Current
Cattle Capacity Population
Number of Structures: ©I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
LQ No
❑ NA
❑ NE
12128104
Continued

1 1.
Facility Number: — Z/ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ 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: ,��/1 )OVt1l
Spillway?: M NO
Designed Freeboard (in): 4 .� N
Observed Freeboard (in): , 150 _5�0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes /No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElyJ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ 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 J
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes g No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Win ow ElEvidencee oaf Wind Drift [IApplication Outside of Area
12. Crop type(s) ,A�ruoA %� ), S5' /0f'lAa, ZAe
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JZNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
VrNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'❑ Yes
�2rNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
7No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
I) 1�s7Kt-r_P'9/z-r 51/0"f0 50�� �z��o5 i"'�w�•�G r �,�E
Reviewer/Inspector Name "`°- Phone: //40— [ — 2
Reviewer/Inspector Signature: Date: (O D
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,06 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other /
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes l( No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PeNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;?fNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�J
l4 No
!!!!!�(
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
[INA
[INE
and report the mortality rates that were higher than normal?
/ICJ
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
yNo
❑ NA
ElNE
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
El Yes
,,,......,,,///
{�J No
El 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
Y_No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:777771
W/- r f l"<' GC / /`l.�i� ► %��%� i�� lQ 26 4�l/ EGG
12128104

of Visit .0 compliance Inspection O Operation Review O lagoon Evaluation
for Visit QYhoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility
cility Number Date of Visit:
Permitted 0 Certifir 0 Conditionally Certified 13 Registered
Farm Name: u N.....[ /
Owner Name:/,,,�O5.7.NG ............ .... .......
]Mailing Address: ...... _........ ._................... ......---........_._..._._......._._......._...._..------......
Below
Date Last Operated Above Thres)lold:..
County: 'f� -I_`Z_...._...._._. _
Phone No:
FacilityContact:.._._._.._......_._._.........._..._..............__._............ tile• .................... _.................._... _. Phone No: _._____._.....___..._.___.....
Onsite Representative:.._.... �'1r� Q t i.�ff�7!�� .._._..... Integrator: _QLOS�QO
Certified Operator..._.........................._..._................_................_....__.........._......._..._... Operator Certification
Location of Farm:
�7f Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current - Design Current Design Cprrent
Swine Ca act o i:Plati, Poultry_ .Ca act .,Po`nlation :Cattle ' , _Ca as Po""6lation
Wean to Feeder OD ❑ Layer ❑ DaiTY
Feeder to Finish ; ❑ Non -Layer s ❑Non -Dairy
Farrow to Wean
="
� Other '
Farrow to Feeder
—
Tdtal Destigin Capadl
Farrow to Finish
o
Gilts
Total SSLW ` w:
❑ Boars
- �Ntnnber of Lagoons
x
H9P
Holdiiii-Po Solid
Trans
_ r
Discbm & Stream ImpaCiS
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 WrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;eNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )dNo
Structure 1 Stricture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _....... ... .... ........ _._._._....... ............................. .... ......... ... _.................. .......... ........ _...... ....
Freeboard (inches):
12112103 ll / Continued

Facility Number: — 2�2 Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
P(No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
R(No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
VNo
8.
Does any part of the waste management system other than waste structures require maintenancefrmprovement?
❑ Yes
)6No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
9No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ONo
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
JdNo
❑ Excessive Ponding ❑ PAN ❑ Hydraul' Overload ❑ Frozen Ground ❑ Copper d/or Zinc
12.
Crop type � FiP/)76/ Q4 .4t /MALL /P�iJ dF. f�
13.
i
Do the receiving crops differ with those designatedin the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ANo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
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
!z(No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
RfNo
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
ONo
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Jam-' No
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
VNo
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
PfNo
Air Quality representative immediately.
S
&152d1'-'Rj9 [ l
Reviewer/Inspector Name ,;-,
41-34
�C'l A
0
Field Copy ❑ Final Notes
Reviewer/Inspector Signature:
Date:
121112101 _ Continued

Facility Number: — Date of Inspection
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0 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
VNo
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONO
❑ 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
ONO
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RfNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie/ discharge, freeboard problems, over application)
❑
VfNo
27.
Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative?
❑ Yes
No
28.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P�No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
INo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form []Rainfall []Inspection After 1" Rain
❑ 120 Minute Inspections []Annual Certification Form
12112103

of Visit )b Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit P Routine O Complaint O Follow up O Emergency Notification O Other
Facili y Number Date of Visit:
0 Permitted ©xy-�
ed C] Conditionally Certified Q Registered
Farm Name: _70/✓ 2-—+----...._.
Owner Name:..._.' .1MAW ....J�_L...._��5.......... .._.... _......................
Mailing Address:
❑ Denied Access
Threshold
Date Last Operated or Above Threshold: .... _.................
County: _.Vw�.
Phone No:
Facility Contact: ....... -.............. _... _......................
�... _... .......... Title: ..... _......................................................... hone No: ................................... _... _........
..,
Onsite Representative:. (►'.T-----� .:.!.i--....................................................... Integrator:....One.0........................................
Certified Operator.
Location of Farm:
Operator Certification Number.
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =a Longitude 0- =` =a
to
to Wean
F��� ❑Other

Facility Number. 3 — `L / Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ire/ 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 maintenancelrmprovement?
9. Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintmancelmprovement?
11. Is there evidence of over
❑ Excessive Ponding ❑ PAN, ❑ Hydraulic
12. Crop type #'F/RMUAA(PAVi ,Smhc(_ GRA-z,-J tf)dfie FA
❑ Yes [A No
❑ Yes /INo
Q Yes ANo
❑ Yes [VNo
❑ Yes (2No
❑ Yes No
❑ Yes '�fNo
13.
Do the receiving crops differ with thost(designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
[ No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
Q Yes
/No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(id WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
1�No
TTTTTTI� No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
Q Yes
VNo
21.
Did the facility fail to have a actively certified operator in charge? i
❑ Yes
( No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
/
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
r
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? .
❑ YesIo
[�
No violations or deficiencies were noted during this visit. You will receive no further correspondence. about this visit
I
Field Copy Final Notes
..d
::
... ..` kk "St k ...� k is _.. . k.. i .._ ..a.. -i k k .a S .<
l� t�FR/�G��s����J �� �,e✓ �,t/,S��G,��-<—,� �fQs��a �i✓S��z2��
8�-sFp D/✓ �D .�• �/�� �'R>i �R �i� fj��o G�/���a /�-P�czcg �zv�
Reviewer/InspectorName {
Reviewer/Inspector Signature: / '10U _ /dL _ / pvt6_Date:

i'�� � ���
s

-Pkovol
Facility Number. / —?,/Zl Date of Inspection
Continued
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor 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?
oSr
D Yes�No
❑ Yes l/No
❑ Yes No
❑ Yes /No
j� Yes 9No
❑ Yes Vl
❑ Yes/El No

mr

of Visit 14compiiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 9boutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: a' D Time: � Printed on: 10/26/2000
Facility Number 1 L
Not Operational O Below Threshold
ermitted [3Certified [:]Conditionally Certified 0 Registered Date Last Operated or Above Threshol : .........................
FarmName:.N:�l:........l..Q!:k�i'.:?.............................................................. County:.... I.....lA.� `.1..._......... .. .........................
..... 11 n
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
Mailing Address: ..................................................................................................................................................... ...................... ...................
.. ...... ......... ......
Onsite Representative: ...
1,.7 r�i.!ti..l........ .......!4. ........................ Integrator: ......'�i!..lP"i^"!.fl......... ...� !.\.P../...
Certified Operator: ...................................................
i.nratinn of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude FI• ", 1 41
Design Current
swine Uapacity Population
Wean to Feeder
![03
Feeder to Finish
Farrow to Wean
Farrow to Feeder
rl Farrow to Finish
Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current
Poultry _ Ca aci Po mlafion
❑ Layer
❑ Non -Layer
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Longitude "01 1 1 11
Design . Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Drains Present
Waste Manaeen
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)
Area
❑ Yes �(No
❑ Yes ❑ No
❑ Yes ❑No
!//d //�
❑ Yis ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes I
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [(No
Structure I Sr?��c 2 .. Structure 3 . Structure 4.. . Structure .5 .. Structure.6....
Identifier: ........................... ... ..... ....................................
Freeboard (inches): -�
5100 Continued on back

Facility NumbDate of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures obseMeV(ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
�No
(If 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
�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
§4No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
U(No
11. Is there evidence of over a plication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
KNo
12. Crop type zk
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
O No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
-E�No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment'?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
El
o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
jNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yeso
21. Did the facility fail to have a actively certified operator in charge?
❑ Yeso
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 91N0
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes qNo
24. Does facility require a follow-up visit by same agency? ❑ Yes qNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
.. K.. vibl'....s.. deficiencies -were holed dirritig this;v.. • Y. will . ecgiye no: fui•thgr ; • ;
corresp6ideike'ah6tif this visit
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. - _
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name y{
Reviewer/Inspector Signature:AA Date: 5/00

Facility Number: — Date of Inspection QoZ I Printed on: 7/21/2000
Odor.IssM
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor 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 kNo
❑ Yes tkNo
❑ Yes Po
❑ Yes f NO
❑ Yes J,No
❑ Yes )d No
5/00

`� T'y - � Drvrsion of Soil and Water Conservation Operation Revrew �- ', �
- 0 Drvtsion of Soil and Water Conservation Compliance Inspection c -� .� ,..
`-ffiIhvrsion of Water Quality ��Compbance Inspection -�- _ ,.r ,�-^�
JW Routine Q Uom laint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection - �p
�/ Time of Inspection / ! p 24 hr. (hh:mm)
Permitted E3 Certi ed 13 Conditionally Certified Q Registered Q Not O erational Da Last Operated:
Farm Name: ....... �7/L7.....L..........I.._ .......................................... County:............ ./�,(�l./.. ........... :.......
Owner Name: .......!(s!:F�'C.22........... PLC. ................................. Phone No:...................
.........- //n- /�, ....................................................................
Facility Contact: %.��.l - e.............<�l7IL�l,_rl............... itle:................................................................ Phone No:...................................................
MailingAddress :..... ... .......................................%..'j...................................................................g....................� OYB /
Onsite Represen tative:
... cv.c.qG...........[.....77K............................................. Integrator:
Certified Operator: ................................................. . ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =0=1 =11 Longitude =• =1 0.:
:Swine
UgYean to F
❑ Feeder to
°° ❑ Farrow to
❑ Farrow to
❑ Farrow to
❑ Gilts
[]Boars
Design : --Current. Design Current_ - - - - _ 'Design,
_-Capacity ..- Current
Ca acit-o ulation Poultry Population 'Cattle-_ ulatiou
"
❑ Layer
-�-:
❑ Dairy
ION n-Layer
-
❑ Non -Dairy
❑ Other
Total D6igntCapacity.;
Total SSLW.._
Number of Lagoons " %� �❑ Subsurface Drains Present ��❑ Lagoon Area ❑Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P(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? �N� —
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 E5,No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes JA No
Strucuire 1 Structur 2,}& Structure 3 Structure 4 Structure 5 Structure 5
Identifier: �Vl���'/
1
Freeboard(inches): ...............1.0.................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. kre there any immediate threats to the integrity of any of the structures o",edls, severe erosion,
ElYes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
tkNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
�O 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 ❑ Hydraulic Overload
❑ Yes
�(No
12. Crop type
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
RNo
b) Does the facility need a wettable acre determination?
❑ Yes
RZNo
c) This facility is pended for a wettable acre determination?
❑ Yes
0,No
15. Does the receiving crop need improvement'?
❑ Yes
5TNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KLNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
,���
(ie/ WUP, checklists, design, maps, etc.)
El Yes
[9No
19.
Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
`( 1No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
4No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
2�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
KNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
2No
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
. . . . . . at .11i. . . (tCt. . . . i. . . . . . oe .. altl. . t�IIS,VISIt. � . . . ,W Ill-t e.M*C tid flu. tflCr,
::
ctiri•esuoticlence:aboutthis visit. ::...::........................... .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary).
d!/SLca� • //�71 rti o� ✓ v li L
oa l
Reviewer/Inspector Name
Reviewer/Inspector Signature: sc-' ,may-/jh , /////// (/ (/ Date: 7 51Oo

Facility Number: 11 — Date of Inspection
Odttr Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below []Yes �No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes <No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes dNo
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 k10
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan bells, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
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
Additional omments and/or rawtngs

I
Facility Number Date of Inspection
Time of Inspection � 24 hr. (hh:mm)
■ Permitted 17 Certified E Conditionally Certified p Registered C of perationa Date Last Operated:
Farm Name: Haustonl.4..................................................................................................... County: Duplin WIRO
Owner Name: ................................................... Maxwell.Faods.Inc............................... Phone No: 9.II1-.778:3. 30..........................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:....................................................
Mailing Address:..P.O..Biix.IA009..................................................................................... Golohharix.N.0 ....................................................... 27532 ..............
Onsite Representative: Ad.Linton................................................................................... Integrator: Goldsborn.Hog.F.arms.......................................
Certified Operator: $arry.S................................. Exam ................................................. Operator Certification Number: I8612.............................
Location of Farm:
Latitude ®• ®' �" Longitude C7�e ®' E_5D —1"
Design Current Design - Current Design'Current
Swine Capacity -Population Poultry, Capacity Population; Cattle Capacity Population-.
g Wean to Feeder
❑ ee Fer to mts
❑ arrow to can
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
pOther '
Total Design Capacity
TotalSSLW
6,400
192,000
Number of Lagoons FO - ❑Subsurface rams Presentp Lagoon Area p pray ie rea
Holding Ponds / Solid Traps t0 ❑ o Liquid Waste anagement ystem
Discharges !& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes g No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes g No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes g 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 g No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes g No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes g No
Waste Collection . c Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes g No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................................back............................................................................................................................................................
Freeboard(inches): ...............2.7...............................35............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes g No
seepage, etc.)
3/23/99 Continued on back
Printed on 11/23/99

Printed on 11/23/99
IJ jizacility7um er: 31-212 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (:]Yes 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 maintenance/improvement?
❑ Yes
H No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
p Yes
® 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?
p Yes
® No
11.
Is there evidence of over application? p Excessive Pending p PAN
p Yes
® No
12.
Crop type Coastal Bermuda (Hay) Small Grain Overseed
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
®No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
®No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15.
Does the receiving crop need improvement?
p Yes
® No
16.
Is there a lack of adequate waste application equipment?
p Yes
H No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
®No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
®No
22.
Fail to notify regional DWQ of emergency situations as required by General Pemvt?
(ie/ discharge, freeboard problems, over application)
❑ Yes
H No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p 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? p Yes H No

I
Printed on 11/2°100
acL
Lty Num er: 31_212
Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
p Yes
® No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Cl No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
p Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
p Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
p Yes
g No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
p Yes
®No
a5
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Printed on 11/23/99

Ope 13.DiviAon of Soil and Water Conservation -ration Review - _
- - [.Division of Soil and Water Conservation- Compliance lnsp`ecGon
ODivision of Water Quality- 'Compliance Inspection ,
[3OtherAgency-.OperationReview''. --- "..
l(WRoutine Q Com laint Q Follow-u of DW ins ection Q Follow-u of DSWC review Q Other
Facility Number Date of Inspection —3®-191
Time ofInspection © 24 hr. (hh:mm)
*Permitted t1C1ertitieed [3 Conditionally Certified ❑ Registered 0 Not Operational Date Last Operated:
Farm Name: �--}tl�R.'.\ \`\��—rx_ County:........1!�IL�"�............................ :.... .......................
Owner Name:.....L?��d 7q V\Q.S..:.................................................... Phone No:.......................................................................................
................................................................................................
FacilityContact: .............................................................................. Title: ................................................................ Phone No:
MailingAddress: ........................ .................. .................................to�rahr:Onsite Representative: ...... ................... .............In...... ....................................
.....
Certified Operator: ...... A7....... . Operator Certification Number:.....�D..p._7
........................................................... .......................
Location of Farm:
Latitude =•='=11 I►.,ongitude =•=' ="
Swine
Capacity Population Poultry Capacity Population Cattle Capacity Population
�(QO ❑ Layer I I[] Dairy
❑ Non -Layer I I0 Non -Dairy
Wean to Feeder
❑.Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
❑ Other
Total Design Capacity
Waste
Total SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field El Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/inin'?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
1
El Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes XNo
❑ Yes O(No
Structure 6
Freeboard (inches) ............ 3............................. ...............
1/6/99 Continued on back

Facility Number: '3 —1A1). Date of Inspection
-' 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes KNo
8. Does any pan 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 top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes �No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
11. Is there evidence of over application? ❑ Ponding dNitroven Ayes ANo
12. Crop type F....Qj...................................................................................................................................................................................................'�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
14. Does the facility lack wettable acreage for land application? (footprint)
❑ Yes XNo
15. Does the receiving crop need improvement?
❑ Yes 1'�4 No
16. Is there a lack of adequate waste application equipment?
❑ Yes E)dgo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes N'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 XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
M No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes gNo
21. Did the facility fail to have a certified operator in responsible charge?
❑ Yes (9No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes [R�No
(ie/ 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 11,No
No.vioiations-or. deficiencies.were noted during.ttiis'visit.. Ynu wilLreeeiv. e no further . .
-'.clit`respotideitee;abbut'this;visit.; ; ; ; ....
'-'-'-'-'-' '-'-'-' ' '•'•'•'•'•'•' ' ' '-' ' '
_.
Comments (refei to question #): Explain any YES answers and/o�'any'cecommendations or any other comments , -'-
Use drawings of facility to better explain situations. (use additional pages as necessary)
l\) :56.,e �,�� t 1ct� d PAN 6
�
Reviewer/Inspector Name
Signature: i; 1 l \\���_ Date: of���� 11/6/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
Date of Inspection'( n
Facility Number —_`a
Time of Inspection®0 24 hr. (hh:mrn)
U Registered Certified 0 Applied for Permit E3 Permitted 1E3 Not Operational Date Last Operated:
FarmName:.....� ....... .........._:....1......................................... County:.........\1.....�h.
OwnerName: ..... C�`....n{�d5................................................................. Phone No:..... ...........................
Facility Contact: 4.n d2..11..e.`). ...................j.......... Title:tom...........................
Mailing Address: _�p... 10P8. 6;3 -5 `�..........................CIDn
.............................
Onsite
Certified
Phone No:
Integrator:
Operator Certification Number; .........................................
Lftcatirm o 'a
.5...................................Q.............._4......................................r..............)............................ a .►it......-..... In ..........
Latitude =• 0' =" Longitude =• =' ="
Design Current Design, ,Current Design ,Current
_.
Somme Capacity Population Poultry Capacity Population Cattle ``.` Capacity -Population N2
09 Wean to Feeder �i00 ❑ Layer ' ' ❑ Dairy
Feeder to Finish ❑ Non -Layer I : ❑ Non -Dairy
+, ❑ Farrow to Wean -
❑ Farrow to Feeder 10 Other I
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSEIN n
Number of Lagoons'/ Holding Ponds ;® ❑Subsurface Drains Present ❑ Lagoon Area I[] Spray Field Area
,�6` _•". LL< E ❑ No Liquid Waste Management System
s
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
2. Is any discharge observed from any part of the operation? []Yes R No
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes N No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes E4 No
c. If discharge is observed, what is the estimated flow in gamin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any pan of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes UNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes [9 No
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaEoonsAoldine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Structure 2 Structure 3
Identifier:
a
Freeboard (ft):.........3..r..a...........
........ 3.:ta.............. ............................. ,
10. Is seepage observed from any of the structures?
❑ Yes KNo
❑ Yes RNo
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of `WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .`1..Sr�.........................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
PL No.violati6ns-or deficiencies. were noted during this -,visit. You;will receive ilo ftirther
correspondepce about this:visit:
❑ Yes IR No
❑ Yes W No
■ *4
❑ Yes (a No
❑Yes ;SfNo
❑ Yes R No
❑ Yes M No
❑ Yes EgNo
❑ Yes ONo
❑ Yes allo
❑ Yes W No
❑ Yes N(No
❑ Yes %No
❑ Yes No
❑ Yes No

❑ DSWC Animal Feedlot Operation Review
®DWQ Animal Feedlot Operation Site Inspection
1% Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number SI 2 Date of Inspection
Time of Inspection R.3U .� 24 hr.
E3 Registered 0 Certified 0 Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated:
FarmName; ........ Aovs.6n....... I.' ....... gem ....................................................... County: ....... 41).�...............................................................
OwnerName: ........ A1.Cft il....... f.U4.......................................................................... Phone No:...q).9d. $r.. 1.3.9.......\........................................
Facility Contact: .... itn..... fra1.t4l..................................... Title: ..... ..M."zr.................................... Phone No:..C.4(.9................
MailingAddress:.... ...Q.... x.......�OQQ9..................................................................... .....Ca.RJ(.5.?.acQ.p...-.`....................................... Z. 153.L.........
Onsite Representative: ..... �pu ........liGLt .. Integrator:....C?.4If)Sloan»....._9M3.............................................
/l`.f............................................................ '
Certified Operator......._klP"d..__...I........... ............................................... Operator Certification .........................
Location of Farm:
Latitude 0• 5 `©" Longitude ®• ®' ®-
Swine Capacity Population
M Wean to Feeder
(,
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer 1 ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity &'tifl7
Total SSLW
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present I❑Lagoon Area I
❑ No Liquid Waste Management System
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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
Spray Field Area
❑ Yes [)d No
❑ Yes IN No
❑ Yes EP No
❑ Yes [p No
❑ Yes
M No
❑ Yes
U No
❑ Yes
® No
❑ Yes
V3 No
❑ Yes
IN No
❑ Yes
M No
Continued on back

Facility Number: 3 t
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
. [$I No
Structures (Lagoons Holding Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
lia
Structure Tt y Structure 3 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: ......... �..._............... ............. 1.......................................................................................................................
...................................
Freeboard (ft):........... X.'.. 1
................................1...................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
N No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type........k.......................................................... ...... .......... SMaI)...�fAin.................................................................................
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?
[I Yes
V] No
18.
Does the receiving crop need improvement?
19 Yes
❑ No
19.
Is there a lack of available waste application equipment?.
❑ Yes
(,� No
20.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
lA 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?
5a Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
54 No-
0 No.violationsor deficiencies were noted during this.visit. You.will receive no further
correspondence about this:visit:: . .
Comments (refer to question #):.Explain any YES answers and/or any,recloutiffiendilationsi or any othercomments.
Use drawings of facility to better explain situations. (use additional pages as`necessary):
I2. tajoo�. � I walls sl.e�ld be nwwcd• $t,,� o,.yg o>n dew,.# I stio�id 6� reserdrd. `
18. I;«-wJa crap sl,«,id be im���e�.
az S�''`j rewYds should lae Vat b hln number wv 0 �ye(� vluyryba' LA,�ot� dcs;y,y ol{
# I e6rt! i tn5a+ion aes�grx IMP yHould be eer{i �icd P�cvt. U�d�{cd axis+c wr r1
sot\ A-esk ahtl�S"s sl'wlU la h ter it'-j p(a,".
23. No (�� ew{ifiCd lo+� Car 'louses _; {+4. p(on skc-4 ba 0A %-, e . C� C,+ Go(Jsdltxo
`45 4C coff2L�ttn. 7/25/97
Reviewer/Inspector NamerPm.:
Reviewer/Inspector Signature' Ate_ L. A14zDate:

r
Li
Farm
Mails
County:
Integrator. .
Site Requires Immediate Attention:
Facility No. Z'!
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 'g — / a. , 1995 f iTime: `9-! A� (W,����1R1Y1 f ' Dk �R, S
Phone:
On Site Representative: y c r Phone: ?M .'�p 93— =—�7
Physical Address/Location: pa
iiwy p v L4 1
Type of Operation: Swine t� - Poultry Cattle 'N LU W, -
Design Capacity: 3 2 O a Number of Animals on Site: ' 3 a.o-o `
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 2_' _00 Q/_" Longitude:7.8�_" fL_' �_" 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) Oor No Actual Freeboard: 3 Ft. Inches
• Was any seepage.observed from the lagoon(s)? Yes or(t Was any erosion observed? Yes o(S
Is adequate land available for spray??/ e or No nIs the cover crop adequate? 0 or No
Crop(s)being utilized oanJjj �Mc.,,:O,
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? loor No
100 Feet from Wells?(t) or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(fD
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or t o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes ore -If Yes, Please Explain.
Does the facility maintain adequate waste management reco s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? or No
• _ C c /�i l�
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.