310217_INSPECTIONS_20171231

NUM I H CAROLINA .M
Department of Environmental Qual

for Visit: 0Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (0 Arrival Time: o Departure Time: 3 n County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Region:
Certification Number: 713t
Certification Number:
Longitude:
Swine
Wean to Finish
Design jurrent
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Content
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
an to Feeder
-2 ZOo CO
Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
I.. P,ouitr,
Layers
Design
Ca aci
Current
P,o ,
Dairy Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
I
Pullets
I
lBeefBroodCow
Other
OtherIn
_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 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 Ej No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [-]No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
/-
[:]Yes ❑ No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r) 9
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
Structure 5
❑i'No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes b ❑ NA ❑ NE
❑ Yes Ej 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
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
a 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
❑ NA
9
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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
[rlo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Wo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑.w?46 ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[],16o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E;[,N�o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q'NNoo ❑ 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 3<0 ❑ 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 In N ❑ 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 214120I5 Continued

lFacility Nttmber: Date of Inspection: r
24 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LLI No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q'l�o
the appropriate box(es) below.
❑ NA ❑ NE
❑ NA ❑ NE
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑'lit — ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Q'1qo_ ❑ 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
E3 Ne- ❑ 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
❑'1qo—❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Io - ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. `
Use drawings of facility to bettereablain situations (use additional oa¢es as necessarv).
'
t6- r e'-,g
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
a a _'-t t
Phone: 10 7 7 L 7 30�
Date: /
21412015

(Type of Visit: t?j Ci pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: NJJ Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I,7I
Farm Name: T
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: Departure Time:® County: Region:
Title:
Owner Email:
Phone:
Onsite Representative: (3 i-n.jr 08=Ua E,LV Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
99r]9
Design Current
Swine @apaciri Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oul[r.
Layers
Design
C_a aci[
Gurcent
Po ,
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
01 Boars
Other
Other
Pullets
Turke s
Turke Poults
Other
Beef Brood Cow
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
. Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 2 ❑ NA ❑NE
❑ Yes Lo No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection. I (o
Waste Collection & Treatment
4'. Is 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
Identifier: wropr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3-
Structure 3 � Structure 4 Structure 5
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?
dNo ❑ NA ❑ NE
❑No ❑NA ❑NE
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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N/� ❑ 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 EZ�'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?
es
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EX<o
❑ NA
❑ NE
acres determination? _
17. Does the facility lack adequate acreage for land application?
❑ Yes
O/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a No
❑ 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, checylie appropriate box beloyv.. �es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard I[Z] 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 ,YNc ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 1� 21412015 Continued

"cility Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WN0
o
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 PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑NA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ca4o ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
[3/No ❑ NA ❑ NE
[7/No ❑ NA ❑ NE
No ❑ NA ❑ NE
9❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft 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).
61) WE6r,> Co►.)MO(, 5TXL4-t0660E0.
ao �s
�o a -
VP
ow►JC — ►v��ss>n/� W�iS �(� 20�S , OSC-0 PhuESC
�s N6 W M)kw►.E
J v�L Te3-P ` -0 O �J.
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: r1 l0)?% _!) j'zg
Date: q1I 8- 11 (c
21412015

Reason for Visit: (3F Routine 0 Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: N III /YJ Arrival Time: Departure Time: County: DLC [ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �, apoa &4_ OO e ` Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
�1_I9' i
Design Current
Design
Current
Design C+unrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I
ILayer
I
Dairy Cow
Wean to Feeder
I 'L4M VOO I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oult_,
C_apaci_
PaoIn
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes /No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes [�
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection: (/ n 117
Waste Collection & Treatment
4. is 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
Identifier: %%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 3 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 Zf No ❑ NA ❑ NE
❑ Yes E�J'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [f� 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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
tQ/ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
0/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
N
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[No
❑ NA
❑ NE
Required
19.
Records & Documents
Did facility fail have Certificate Coverage & Permit
Yes
N
NA
NE
the to the of readily available?
❑
❑
❑
20.
Does the facility fail to have all components ofthe CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WOP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E2<o ❑ 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 N6o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection, I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA [3NE
254 Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes ZNo ❑ 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
2fNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
dNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
zNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
. If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo ❑ 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).
CL"#aj Ar otii✓9 Fo_ cite CT&a NCEDS WC 6 D
tO//796 ( ,
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
0� Phon :? b '�Jff
re: Date: 6 II )S
214 I5

_ /IF
Type of Visit: Wcom lance Inspection U Operation Review 0 Structure Evaluation 0 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: �J ! Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Zk)QC..r EASQU%
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator: 1
Certification Number: t"��l 0, 1
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capactty
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
2 -b
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D. P,oultr.
Layers
Design
Ga aci
Curreut
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
IMI Other
Turkeys
Turkey 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 [/ NNo [:]NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[]NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes VNo❑NA ❑ NE
❑Yes ❑ NA ❑ NE
Page I of 21412011 Continued

' Facili Number:
Date of Ins ection: $ /
t Waste Collection & Treatment
�4. Is 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 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 15�O
[0 No ❑ NA ❑ NE
❑No ❑NA [3 NE
Structure 3 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 No ❑ NA ❑ NE
❑ Yes;No0
❑ 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 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 ❑ T Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesZ No ❑ NA ❑ NE
maintenance or im rovement?
P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes CZ"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
VN❑ 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
W " ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V ❑ 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection.
i 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes n ❑ NA ❑ NE
•25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes VNo ❑ 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 �I ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality Fetes 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 CKO ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ YesC, No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
❑ Yes Ej No
❑ Yes L�J '�
❑ YesNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings -of facility to better explain situations (use additional maces as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature',
Page 3 of 3
Phot
Date:

Reason for Visit: Qf Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit 3 Arrival Time: Lip Departure Time: OJ County: OAIJL4W Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
OnsiteRepresentative:UsSU
Integrator:
Certified Operator:
Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
ZIRCiI
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
^Zap 3Z. D
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P,oult .
Layers
Design
Ga aci +
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 0 No ❑ NA ❑ NE
[—]Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes V ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: Date of Inspection: y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier: IA&COJO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3
❑ Yes
[`No
❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes CNo ❑ 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 N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YO ❑ 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 No ❑ 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
[Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
VYes
❑NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yeso
Do
❑ 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
❑ NA
❑ NE
7777
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 1" Rainfall Inspections / ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes �uo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 2 Date of Inspection. L( /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L � N ❑ 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 to provide documentation of an actively certified operator in charge? ❑ Yes N/o ❑ NA [3 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes I <0
❑ Yes 2 No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes la o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
0N[�❑NA ❑NE
❑ 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).
Lj 0 Cat-7rR_0L_- OeC-D&0 ror` Vc--<w& rzkt.q
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
�Jolgt4 N Ll. Phone:(TI(o)-7
/7y 3-V
'1 Date: ZT3 ( 3
21412011

Reason for Visit: C.) Routine U Complaint U Follow-up U Referral U Emergency U Other 0 Denied Access
Date of Visit: q /1:E1 Arrival Time: p© Departure Time: (l County: btip Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: J L)O C, 'RAS[�E13
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: QARN
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
W,et Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
�jOO
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Dr. + P,ouI
Layers
Design
Ca aci +
Current
P,o
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
I lBeef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Io ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes Ny ❑ NA ❑ NE
❑ Yes N� ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 21412011 Continued

F/
�FacilitZ Number: 31 -1;L1'1 I (Date of Inspection: X I911�
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
Identifier: k_ACTCa�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 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 No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen�al threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EfNo ❑ 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 E�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q 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
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
✓[,YYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑' NNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required Records & Documents
�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. 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 min gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ExNo ❑ NA ❑ NE
Page 2 of 3 V412011 Continued

Facility Number: 3 ( - Date of [ns ection: . L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes '[!�No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes [3] N ❑ 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 C],<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EV<o ❑ 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
[ErNo
❑ 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
ffNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�
rjN
NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yeso
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
6440
❑ NA
❑ NE
Comments (refer to question tl): 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).
ts,) C4 x1,/vE w cF cON IruuI ke � 7ZCV C v �N � 1,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: `i 112/
21412011

(Type of Visit (?rCoy_❑-pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit lJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other Denied Access
Date of Visit: Arrival Time: ® Departure Time: FL--%77 County: L'r Region:
��T�T�
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: C�oUGGLAS 8AS0&J
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , Longitude: = o = ,
- Designn Current-,-Destgn Current '" ' �
..Swme�- `: •"'Capacity: Population,- 'WelPulty,t•C"n "Caly o
Destgn Current
cttyu_liation:.,.
El
Wean to Finish
„❑ Laver
❑ Dairy Cow
Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑
Feeder to Finish - .: ❑ DairyHeifer
Farrow to Wean Dry Poultry _ ^ ❑ D Cow
Farrow to Feeder "'"" ❑ Non -Dairy
Farrow to Finish , ❑ Layers
El Beef Stocker
Gilts ElNon-Layers El Beef Feeder
Boars : ❑Pullets
❑ Beef Brood Cowl
❑ Turkeys
_ El Turkey Pool Is "
�^
Othery... ❑Other •_; Number of Structures
:.
El
El
7
El
El
W
❑
Qther
❑
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
❑ NA
❑ NE
❑ Yes ❑ o
❑ Yes Nt5
❑ NA
❑ NE
❑ Yes UlNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment I I
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
j �Structure I Structure 2 Structure 3 Structure 4
Identifier: (A&m/-,�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): V-1
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 EJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes INNp ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t¢teat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesL1I/mo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require ❑ yes C/// No ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes ff No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CdNo ❑ 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
15. Does the receiving crop and/or land application site need improvement? ETYes
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
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
0"'No ❑ NA ❑ NE
to ❑ NA ❑ NE
L No ❑ NA ❑ NE
Comments (refer'to queshbn #): Explain tiny YES answers and/or,auy recommendattods or any other comments -
Use drawings of facility to better explain situations. (use additional pages as necessary)
IS,) F FIB CvNo L
�i✓ FSdG�F �'_zEc 0 0✓l-EDF
Reviewer/Inspector Name
Reviewer/Inspector Signature:
p �,.Aef
Phone:
Date:
Page 2 of 3 1 12128104 t Continued

}.Facility Number: 3 / -`A/) I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z6NN ElNA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑yes ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi n El Mans El Other
g
/
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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 V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
IQ/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dt4
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
❑ 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
L^d,"/N
El NA
I--]NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/
30.
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
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
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Co 'lance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I �16 l Arrival Time: Departure Time: County: DL0LZFJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: buc' `OASDEA Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' Longitude: = o ET
I=] „
Design Current
Design Current
Design Current
Wet Poultry Capacity Population
CattleWean
to Finish
❑ La er
❑ Dai Cow
12 Wean to Feeder
Z�
❑ Non -La er
❑ Dai Calf
Feeder to Finish
❑ Dai Heifer
Farrow to Wean
lot,
❑ D Cow
Farrow to Feeder
ersFarrow
❑ Non-Dairy❑La
to Finish
Beef Stocker
Gilts
❑ Non -La ers❑
❑Beef FeederBoars
Pullets
Beef Brood Co❑
Turke ser
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E2No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑ NN ❑NA
❑ NE
❑ Yes
❑ Yes
❑NA
[INE
❑ Yes
Zo❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: l Air"Zfl )
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes
No ❑ NA
/
❑ NE
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 6d No ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ E Yes N [I 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 NJ No ❑ NA ❑ NE
maintenance/improvement? (/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Eld Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dN, ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
L Co ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
BNo ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
El Yes
ElNA
ElNE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments" refer to qnestiim # t Explain any YES answers and/or`an recommendations mr an other comments
,Use drawings of facility -to; better: explain situations. (use addrhbniCpages as necessary:):' - =" -� --t= ""ntn
. _ _.. ._.. ....
MAY I.OV3 Y-WtPS�J(r D=6 rear l A
h/fl9T6~�SU L Yx
Mist- IJAUG A "-P-oSDJG TO 9C-(LWt-t:r w'tT41=n./ (So OAQS Y3Llr�c�'E
�E ar iE2 C�et.�j. PUA3 , 064OT LET I-IAPP(tJ
IIGAMN.
Reviewer/InspectorName `7_of;/J �la2Ai�
Phone: It7
Reviewer/Inspector Signature:qCUn�,Date:
Ll & Ito !1�
Page 2 of 3 r 12128104 Continued

4 Facility Number: 3 j — Date of Inspection
iRequired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Ma s El Other
P
21.
Does record keeping need improvement? If yes, chec the appropriate box below.
Yes
El No
El NA
[I NE
El 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
o
❑ 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
to
[INA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
� Co
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U iO
❑ 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
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
UN(
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Io
❑ NA
❑ NE
(Additional Comments and/or Drawings: .'• - '" '
Page 3 of 3 12128104

Type of Visit ,C(9mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �(l Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: © Departure Time: County: uPc— Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: P6d(s BRSOFa1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: Do 0, 0 Longitude: 00 0, 0
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capes ity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
Wean to Feeder 374o 1,11
10 Non -Layer I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El 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 IJ• No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑I No
❑ Yes
LdDIo
ElNA
❑ NE
❑ Yes
[1] No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

FaSility Number: — a f Date of Inspection
Waste Collection & Treatment . /
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ ld 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: 1A &-O-A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
iNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
2 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�j1J 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
_ (/
ZI No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L'J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
ON
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
F No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6No
❑ NA
❑ NE
2b) Gt/piY hgA1&yjU X4M(D LV 7-040- ?4_CAJ(- o3(- j_rMEIP. Sprh US
IReviewer/Inspector Name I a �A(l (,L I Phone: yQ 2 - I
Reviewer/Inspector Signature: Date: VI) .fQ
a -- 7 -t 2 12/2R/t)4 Continued

Facility Number: 3 I — di -I I Date of Inspection
Required Records & Documents
I9� 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 El Yes LJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, the k the appropriate box below.
L�J Yes
❑ No
El NA
❑ NE
❑ Waste Application ElWeekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspection�No
Weather Code
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
EdNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,E/.I
CJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
[,dNo
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
u 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
E�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
eNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
nNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number 3 2�'►
Q Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency.
Type of Visit Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `i g aP Arrival Time: Sb0 Departure Time: County: 001-21J Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: DoU& AS Rn&nCPj Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 1 o = = Longitude: = ° = I
Design .Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
$Lap 13250 1 ❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design " Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ='
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L2 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑ N ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
[:1 NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

1 �t.
[acility Number: 3 (—U T� Date Inspection f 0
of
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes
/
O 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: LA &Iamj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): %la
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElE 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?
El Yes
12<0
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
/LI No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
IG No
❑ NA ❑ NE
. maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CJ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CJ No
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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
tfJ No
�No
LJ�N
L7No
D40
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA El NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/inspector Signature:
Phone: ri —
Date: g1910

t`
Facility Number: — Date of Inspection
Required Records & Documents r ' /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ 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 I? No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Weather Code
Rain Inspections.
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(/❑
20
[I NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Zo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
Z
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
7
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
,�❑,(7�yA
I(J NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes7N9
2
❑ 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❑
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
❑ 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
VNo
❑ NA
❑ NE
Additiohal'Comments and/or Drawings "`
Page 3 of 3 12128104

B Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit (2rCo liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S 11 '% Arrival Time: F/—,.7v,7s Departure Time: County: /J y� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: DoV &-LA. 6#q.SP6A/
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: O o = ' = Longitude: 171 o 171, M 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
3'1/dtt 1 Woo 1 ❑Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
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 Z No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
[--]No ❑ NA
❑ NE
0
❑ ❑ NA
ElNE
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
JCJ No ❑ NA
❑ NE
12128104 Continued

t Facility Number:
Date of Inspection
t 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: IlAC1Ir�, L') I
Spillway?: r—
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
. through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes El No ❑ NA ❑ NE
❑ Yes ONo ❑ 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 ID No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IJ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,(/
9. Does any part of the waste management system other than the waste structures require ❑ Yes P I No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? ,_,(/
I L Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes �l No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
Vs
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
R No
❑ NA
❑ NE
❑No
El NA
❑NE
El<
❑ NA
❑ NE
�io
❑ 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):
IJ, C.i OVU46 T° w6E19 C01VTfZv1_ 6a7�
Reviewer/Inspector Name '% o Phone: q 3
Reviewer/Inspector Signature: Date: J U
r I2128104 - Continued

• Facility Number: — Z,1 j Date of Inspection S tt o
�dteguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IQ 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 ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking EKrop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? El' es No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IZFo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �U/1fil.7r-, ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? es VJ No ❑ N ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes M NN9 ❑ NA El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes U 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? El�
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? El Yes C No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes (GNo ❑ NA ❑ NE
Comments and/or Drawings:
12128104

6Division of Water Quality
FacilityNumber 31 717 0 Division of Soil and Water Conservation
-- O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit td Routine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 4j ' Departure Time: County: 0uat„DJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: Dou(G tZA_wW
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: D 0 0' 0 Longitude: 0 0 0
Design Current
I)estgn ' Current `" ' Design _C rr (2t��
Swine _
Capacity Population Wet -Poultry
Capacity Population `-Cattle V. �: -
'Capactty.`Population^'
AAl
Wean to Finish
IIL ❑ Layer
I
❑ Dairy Cow
® Wean to Feeder
U%
/ 60
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
I
.
_q
. ❑ Dairy Heifer
❑ Farrow to Wean
!
Dry Poultry
_
_ ❑ Dry Cow
❑ Farrow to Feeder �, ❑ Non -Dairy
�- ❑Farrow to Finish
El Layers
Beef Stocker
ElNon-La
Gilts
El:
❑Non -Layers
❑Beef Feeder
❑ Boars
�,_ El Pullets
i
I ❑ Beef Brood Coyd
- - --.
-- Turkeys
Other
❑ Turkey Poults
❑ Other
11 .. El Other
Number pf Structures 4.
�i. t, "
- '
--
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
o
❑ Yes
o
❑ NA
[I NE
El Yes
LI No
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — a { Date of Inspection F 3 Ti 7iati
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 Gv &) 1
Spillway?:
Designed Freeboard (in): 19 ,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ldNo ❑ NA ❑ NE
❑ Yes eNo ❑ 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? ElYes 9/No
El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L'J 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 ADDlieatiOn
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 21Nc ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN [--IPAN > 10% or ] 0 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) Gzwc--, ( GQEet.wmoA L ra) S6 D
13.
Soil type(s) 60A R0. 1�. e
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2<o ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
N❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El�/o Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
� ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
V ❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any recommendations orany other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
;4) /� ArM(.Y AND /" JZiZJ SA11f'�GTtO.,JJ wows Tp B@ Kceb&967D. �
Reviewer/Inspector Name I �' I Phone: (9/0) 7%- X14 9--
Reviewer/Inspector Signature: q��, �7pt UqQ D Date: 3f!IT(e(p

Facility Number: 31 — 2,17 Date of Inspection IJ d6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. L7 t" es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil alysis El Waste Transfers ❑ Annual Certification
❑ Rainfall El Stocking El Crop Yield El120 Minute Inspections L✓� Monthly and I" 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?
Comments and/or
❑ Yes ZN El NA [I NE
❑ Yes I� No ❑ NA ❑ NE
❑ Yes
YT,
❑ NA El NE
ElYes
(g/No
❑l El NE
El Yes
[I No
NA ❑ NE
El Yes
El No
��
NA ❑ NE
❑ Yes L7 No ❑ NNA El NE
El Yes ❑ No 0/A ❑ NE
❑ Yes UENo ❑ NA El NE
El Yes EINo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes
El NE
El,�,
Yes
�No
N
NA
[I NA
❑ NE
❑ Yes
�I No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 6 Routine 0 Complaint O Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: Z County: Region: i;<
Farm Name: !Y Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 0 `/ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = U = ' =„ Longitude: = ° = ' = „
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
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 0No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�2rNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
OYes No ElNA ElNE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
ElNA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
to
6.
Are there structures on -site which are not properly addressed and/or managed
❑ Yes PNo
❑ 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
notify DWQ
7.
Do any of the structures need maintenance or improvement?
���threat,
Yes No
El Yes
❑ NA
❑ NE
8.
Do any of the stuctures 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
❑ Ye No
❑ NA
❑ NE
maintenance or improvement?
Waste ADnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9No ❑ NA ❑ NE
maintenance/improvement? _.,(
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El,YJ 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 Q Evidence of Wind Drift ❑ Applicgtion Outside of t)rea
12. Crop type(s)
13. Soil type(s)
14.
r
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?
9Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
XNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
L�No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[2fNO
❑ NA
❑ NE
IReviewer/Inspector Name �f� (� {Phone: MV '9 YY� — f [
Reviewer/Inspector Signature: /d /� Date: I
Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? XYes,,,,����(({(N��•�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the approprimte box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Rfyes []No ❑ NA ❑ NE
,,,,,J ❑(((Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers El Annual Certification
,YRainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections '0 Monthly and V Rain Innsppections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? (yJ Yes ElNo ❑ NA ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes OfNo ❑ NA ❑ NE
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 No ❑ NA
❑ NE
❑ Yes No ❑ NA
❑ NE
❑ Yes XNo ❑ NA
❑ NE
❑ Yes ❑ No JdNA
❑ NE
❑ Yes XNo
❑ Yes �zNo
❑ Yes /No
❑ Yes ,,,��No
ElYes No
❑ Yes �dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Adilitkmal Comments and/or Drawin s:
41,10 7-
�� � �y2� /O lFtr/N6� U/�%S>,� //r✓� �Sds (,o2�7't�
49G
`ram - P715 -6 I85 5
12128104

iType of Visit 0Compliance Inspection O Operation Review O lagoon Evaluation
for Visit 9'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Q Permitted 0 Certified [3 Conditionally Certified 13 Registered
!,Farm Name: .....
OwnerName: _ _.Q \f..� �....� 14.5...40..........................._.........._...._...........
Mailing Address:
Facility Contact: .............. _.... _..................... _........... r ......_`_Title:
Onsite Representative: Z 1�g 4,,,��(j ��(!J_
CertifiedOperator: ._...................... ._..... _... _.... ............. _..........................
Location of Farm:
MIM
Date Last Operated or Above Threshold:..
County: 10(15a1.�_........... ..............
Phone No:
Phone No:
Integrator:._.(�LCd
Operator Certification Number:
. wine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =' =11
Wean to Feeder Lj O 1❑Layer a[]Dairy
Feeder to Finish 10Non-Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder Other - =
❑ Farrow to Finish
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Swcture 2 Structure 3 Structure 4 Structure 5
Identifier: _..`._............ _.........................
.............._._......._.._......._......._.................................._......._.._._...._.._..._..._.__ .......
Freeboard (inches): _
❑ Yes 0No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes B fqo
❑ Yes �21lo
❑ Yes 0<0
Structure 6
12112103 Continued

(Facility Number: 3� —a� % Date of Inspection / Q
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
;KNo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
;2'No
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenancelimprovement?
❑ Yes
XNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
JVNo
9.
Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
P(NO
elevation markings?
Waste Application
10.
Are there any buffers that need maintenancelimprovement?
❑ Yes
VNo
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
ONo
❑ Excessive Ponding ❑ PAN Overload ❑ Frozen Ground ❑ Copper and/or Zinc
'Hydqulic
12.
Crop type Q /44r
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?
Otes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
;WNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes .2'No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4 No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes,VNo
Air Quality representative immediately.
Field Copy ❑ Final Notes
%f*n 04,-I- 71«,E5
/�) FfSCuF FZ.ELD r5j �UEiP/h6/.Df} s�z�GQ NEE,05 /o /��'
Cup
Reviewer/Inspector Name i`%
Reviewer/Inspector Signature:
Date:
Continued

Facility Number: 3 _a Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes �6`o
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 XNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
P"Yes [INo
❑ ,,,......///
Waste Application ❑ Freeboard Ip Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes VNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ONO
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes )gNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes XNo
28. Does facility require a follow-up visit by same agency?
❑ Yes ;ff No
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ONO
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes XNo
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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
23) IV,6F0 7 ""-,,6
/1I� Gr/�Is7f S���s �i��_..✓ ��yw�E�
�/�28103 T 313116
Av 'Ao z4e 3�3i�� 0005i 19 Cf5�5
'5D `i92 �yS jv�,9o,
12112103

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit xRoutine O Complaint O Follow up O Emergency Notification O Other
Facility Number Date of Visit.
y
E3 Permitted Q Ce%rtrified QCond`itionally Certified [3 Registered
Farm Name: _....-.'...t.-'--...
Owner Name:......._: n Q:............... Fill. ........... -- ... .—..... ... .........
Mailing Address:
Not
❑ Denied Access
FW
OD
ionai O Below Threshold
Date Last Operated or Above Threshold: ..
County: :I filq ��i✓- ........................... ...........................
Phone No:
Facility Contact: .........
................ -............. - .......
- ... .... ...... _..... .... Title: ...........................................................
Phone No:
Onsite Representative:.N.!Z
J.J ...Ai...._�....
F.ilt1�F—l. .....................
................................................_....._
Integrator....t.L..P���................ _..........................
Certified Operator.
Location of Farm:
Operator Certification Number-
7 Swine ❑ poultry ❑ Cattle ❑ Horse Latitude I * II` l" Longitude =0 =` =-
Wean to F
Feeder to
Farrow to
Farrow to
Farrow to
Gilts
Other
No
Drains Present
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ['I 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 D W Q)
c. If discharge is observed, what is the estimated flow in galfmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Area J❑ Spray
El Yes Io
❑ Yes ❑ No
❑ Yes M No
❑ 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 I/E No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes /No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ..........✓A

Facility Number. — Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed`? (ie/ trees, severe erosion, ❑ Yes JVNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes VrNo
(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? 0 Yes VNo
8. Does any part of the waste management system other than waste structures require maintenancefunprovement? ❑ Yes �(No
9. Do any smctu es lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [gNo
Waste Application
10. Are there any buffers that need maintenancehmprovement? ❑ Yes o
11. Is there evidence of over application? ❑ Excessive Pond ing��tt ❑ PAN Hydraulic Overload ❑Yes /XNo
12. Crop type L&RAMIQAt tOAJI(j FE U f= (I QtJ,R0L C Z"�
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Animal Waste Management
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
(CAWMP)? ❑ Yes CZNo
18. Dees the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIJP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) .
23. Did Reviewer/Inspector fail to discuss reviewfmspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? .
No violations or deficiencies were noted during this visit. You will receive no further correspondence about
menfs �+ei'er tntkneatvgn�J. 7�iiam aa�`�S'ttasweca aadtorsapaeemnmendafioaai prang aYT♦erent
irawitt�<affacilityYuHettnrrspiahr�,�nseaddat�gea�<�•=sai��, ...�.- ..,`'-,�_,;
Fteld Copy ❑ F.
i 08A,5LI rF_p v
IFfGS yFj� (BHSFD �/V zoo/ So�L S KEPORT��
❑ Yes zNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
[]Yes /No
■
❑ Yes JZ(No
❑ Yes XNo
❑ Yes X( -No
❑ Yes XNo
El Yes XNo
❑ Yes jXNo
❑ Yes ko
❑ Yes R(No
Notes
`5P9A�FZELD5 Loot, �o
Reviewer/Inspector Name r
Reviewer/Inspector SignatureDA j� Date.
G'V

0-110310I
Facility Number. — j Date of Inspection
Continued
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 permanenthemporary cover?
❑ Yes VNo
17 Yes o
N
❑ Yes No
❑ Yes VNo
❑ Yes ko
❑ Yes [�No
❑ Yes /❑ No

c t Division of Water Quality
Q;Division of Soil and Water Conservation
0 Other Agency
of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit Time: : Printed on: 10/26/2000
Q tt Operational Q Below Threshold
13 Permitted Certified 00 Conditionally Certified E3 Registered Date Last Operates r Above ThreslypId: .........................
Farm Name: (\ 1.............. � 1W...................................................... County: ......... U((1/./.I %d............./1...%n/......... ......................
.............. .. l e
OwnerName:.._..._....G..!'.:C..............rn.`a.A`-:d:1................................ Phone No:......................... .............................................................
Facility Contact:
Title:.....btil%lll.- ..................... Phone No:
Mailing Address: .............................................................................................
-L.................................................................... ..........................
..................... .. ...
Onsite Representative: .\.. ata,(.,..l.ark.]a+s�.................... ........a. fir'.:!.^.... Integrator:.......... �1°`15�......!..'.'.\.a......i
Certified Operator: ........................ .......... .............................................. Operator Certification Number:............................:::...........
Location of Farm:
Swine []Poultry []Cattle []Horse Latitude =• =' =-- Longitude =• 0' =..
Design Current
Swine Capacity Population
Wean to Feeder
j-0tj
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry capacity Po wlatiop Cattle Capacity Population
❑ Layer ❑Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JEI Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps E:= ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) El Yes ❑ No
c. If discharge is observed. what is the estimated now in gal/min? —AA —
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P`No
Structure I Suucturc 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..........4.--q..................................................................................................................................................................................................
Freeboard (inches):
5/00 Continued on back

Faeility Number: — Date of ]inspection Ea09 0 Printed on: 7/21/2000
5.
Are there any immediate threats to the integrity of any of the structures obse ed. (ie/ trees, severe erosion,
❑ Yes
K 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
�� (/�,
40
(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 maintenancelimprovement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ,_
❑ Yes
15(No
Waste Application '
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is [here evidence of over application? ❑ Excessive Ponding ❑ PAN [IHydraulic Overload
❑ Yes
o
12.
Crop type
13.
1b1_
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�,�lo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
E�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
0 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?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
9No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
V, No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'.?
❑ Yes
ONo
24. Does facility require a follow-up visit by same agency?
❑ Yes
allo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
N0•vi0la(i0fis:or deciendigwerp6tea diWiig this:visit; - Yoiwll4&6ye do fufh.iee t
corresn�dece.abotithis visit.
and/or
1 r
�7� Yvw e �• q w fit' S W�wl C vJ q vv^ Sere -
y-t;Cenrv�(—
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5100

Facility Number: Date of Inspection Printed on: 10/26/2000
'L-H
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
�[
p� 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
p0 No
roads, building structure, and/or public property)
, `
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
0No
30.
Were any major maintenance problems with the'ventilation fan(s) noted? (i.e. broken fan bells, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
[ kNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
1�No
p(1 No
5100

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
CERTIFIED MAIL
Douglas Roger Basden
K&D Farms
1219 Quinn Store Road
Beulaville NC 28518
Farm Number: 31 - 217
Dear Douglas Roger Basden:
OC 1 2 5 nuo
October 23, 2000
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
You are hereby notified that K&D Farms, in accordance with G.S. 143-215.10C, must apply for coverage under an
Animal Waste Operation General Permit. Upon receipt of this letter, your farm has sixty (60) days to submit the attached
application and all supporting documentation. In accordance with Chapter 626 of 1995 Session Laws (Regular Session
1996), Section 19(c)(2), any owner or operator who fails to submit an application by the date specified by the
Department SHALL NOT OPERATE the animal waste system after the specified date. Your application must be
returned within sixty (60) days of receipt of this letter. Failure to submit the application as required may also subject your
facility to a civil penalty and other enforcement actions for each day the facility is operated following the due date of the
application.
The attached application has been partially completed using information listed in your Animal Waste Management
Plan Certification Form. If any of the general or operation information listed is incorrect please make corrections as noted on
the application before returning the application package. The signed original application, one copy of the signed application,
two copies of a general location map, and two copies of the Certified Animal Waste Management Plan must be returned to
complete the application package. The completed package should be sent to the following address:
North Carolina Division of Water Quality
Water Quality Section
Non -Discharge Permitting Unit
1617Mail Service Center
Raleigh, NC 27699-1617
If you have any questions concerning this letter, please call Theresa Nartea at [phone] extension 375 or
Stoney Matthis with the Wilmington Regional Office at [phone].
Sizly, f ,
for Kerr T. Stevens
cc: Permit File (w/o encl.)
Wilmington Regional Office (w/o encl.)
1617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Facility Number Date of Inspection Time of Inspection 24 hr. (hh:mm)
E3 PermittedCertified E3 Conditionally Certified 0 Registered 0 Not O erational to Last Operated:
FarmName:........./............_....................................................... County:......... ../C.V.................... 6.:.........
Owner Name: ....V,
Facility Contact:
Mailing Address:
Onsite Representa'
Certified Operator:
Location of Farm:
....................................... Phone No:.......................................................................................
��%u��
Title: ... X................................. Phone No:...�.-5.....1`.5�.-.S.aCQ
Operator Certification Number:
Latitude =• 0' =11 Longitude =• =` =11
S •ne
Wean to Feeder
.; ❑ Feeder to Finish
°: ❑ Farrow to Wean
-` ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
F1 Boars
Number of Lagoons
Holding Ponds / Solid Traps
Poultry
❑ Other
TotahDesign Capacity -
Total SSLW =]
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I. Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes allo
❑ Yes [:]No
❑ Yes ❑ No
i ./n _
[]Yes ❑ No
[]Yes 'VNo
❑ Yes X'No
❑ Yes D(No
Structure 6
Identifier:
Freeboard (inches): .....
(........................... ...................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1 No
seepage, etc.) '
3/23/99 Continued on back

Facility,Number: 3 - / Date of Inspection
•
d. r Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADDlication
W
❑ Yes 9No
❑ Yes � No
❑ Yes tip No
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ANo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
VNo
12.
Croptype 8y
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
40
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
9No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
N0
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
f No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
IQI No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
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
i�0 V10�8t10I1S ,OP deflcl ndiC S-were IIOt,Cd.dtH°Hlgtbis,vlslt'- Yott WItl-I•ebd*42 lib f�utill r•. ,
::comes ondenceabouEth::::::::'::':::':':':':':'::... .
Comments (refer to qu`e-sti- n #)i Explain any YES answers and/or any recommendatioo_s oc an -other comments e
Use drawings of facility tc bette"r explain situations. (use additional pages as necessary):'.m t,..
-' _ ... -
I /l/�/ /, , �U�/� /t.���J/�Jj• Yf�L�/
-
Reviewer/InspectorName
Reviewer/Inspector Signature: Date: / —
- �/ /Ul ` - 3/23/99

Facility Number: ?J — Date of Inspection
nAor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
ANo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
j No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
UQ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
04 No
Additional omments and/or rawtngs;. <._ _ -

• '_- - ' 3Divisiort of Soil and WaterConservation = Operation Review
3 Division of Soil and Water Conservation -Compliance lnspection
�Division of Water QualityCompliance Inspection
0Ofher-Agency - Operation Review.' - _ - ``r " �e•.
' Facility Number 2i I
Date of Inspection
Time of Inspection
❑ Permitted 19Certified i] Conditionally Certified 13 Registered
FarmName: ..... K�tD....{{..'.`..7............................................................................
OwnerName: ..... �!!�....�1�........................................................................
...............
Facility Contact:
Title:
MailingAddress: .............��'...''..}..................................................................................................
Onsite Representative: , l,l,L^4R-`�
..............................................................................................
Certified Operator:
Location of Farm:
County:
Phone No:
(� 3� 24 hr. (hh:mm)
Date Last Operated:
...............
-1 it
... h......................................
................................................................
Phone No:
............................ .................
`.......................................
..........................
Integrator:......... ....._...............................................
Operator Certification Number:
Latitude F--1' =' =R Longitude 0. 0' =11
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder
32Gp
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I0 Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes �fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 1�(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard(inches): ............. �A.................................................................................................................................................................................................
1/6/99 Continued on back

Aacility Number: 3 — a Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes krNo
(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? Oyes &No
8. Does any pact 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
ZNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
M No
11.
12.
Is there evidence of over application'? ( ❑ Ponding ❑ Nitrogen
Crop type /......�.... 1_,
❑ Yes
gNo
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
[YNo
15.
Does the receiving crop need improvement?
EyYes
C] No
16.
Is there a lack of adequate waste application equipment?
El[y Yes
No
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes NfNo
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 YNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) [VYes ❑] No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONO
21. Did the facility fail to have a certified operator in responsible charge? ❑ Yes (NNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes EYNO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? - ❑ Yes ONO
24. Does facility require a follow-up visit by same agency? - ❑ Yes (gNo
No.via Aoils'or. deficiencies .were noted during.Ibis visit.. -Wu will-reeeive nv further.' .'
atirrespotidenee'abb0fthis 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)._- _-_ --
Tj\ _
V-P_"
Reviewer/Inspector Name h _ - - - _
IReviewer/Inspector Signature: _l ��, �1��_ Date: 11/6/99

Division of Soil and Water Conservation [3 Other Agency
IjDivision of Water Quality
Date of Inspection
Facility Number l�l J
Time of Inspection 30 14 he (hh:mm)
Registered Certified 13 Applied for Permit 0 Permitted [ Not O erational Date Last Operated:
..........................
Farm Name: ....... .....j....................
............................................................................... County: .......... .r......... 1........../_i.l.......................................
Owner Name:..... .` `��.. V.l% 4 ` �..................................................................... Phone No:.�._.1�}- $.n............................--
Facility Contact:
Title:
Mailing Address: ....Ut A.... �.Y%t r�..Z-A.F". ..! �................
Onsitc Representative:.... l.1,y..'.:Q.......................................................................... Integrator:
Certified Operator,
Phone No:
Operator Certification Number; .........................................
Lpeatiqn of arm:
........... ........-c!^�-�F............,...........................................................................................................................................
Latitude 0•=, 0" Longitude 0. =, =11
a Desrgn ; Ctirrentr Destgn Current Design CCurrent -
Svrme v a s CapacrtyFPopulation Poultry _.Capacity Populatmn Cattle, Capaetty Popalatton;a'
OR Wean to Feeder 3-4-Cv epGQ �' ❑ Layer ' ❑ Dairy s--
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean- -
"I[] Other v
_- ❑ Farrow to Feeder
❑ Farrow to Finish Total Design Capacity
❑ GiltsUm
t
'I[] Boars - Tota1 SSLVV
W.. .. .e e.. <.
,*Numiie fLag&aM Hot "Ponds: ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
,. ❑ No Liquid Waste Management System
:. -,
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
& No
2. Is any discharge observed from any part of the operation?
❑ Yes
9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
ONO
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
c. If discharge is observed, what is the estimated flow in pt/min?
5No
�-
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
P4No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
( No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
9No
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JZ No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
(kNo
7/25/97

Facility Number: 1 —a
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoons.11oldiny Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
./.............
Freeboard (ft): •.................
7
Structure 2 Structure 3
10. Is seepage observed from any of the structures?
❑ Yes (X No
❑ Yes 0 No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14.' Is there physical evidence of over application?
(If in excess of WMP, or Rnoff entering waters of the State, notify DWQ)
15. Crop type
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
❑ Yes IN No
0 Yes ❑ No
01 t3 I
❑ Yes KNo
❑ Yes O No
❑ Yes P(No
El Yes C5No
❑ Yes Ej No
❑ Yes IdNo
(9Yes ❑ No
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes id No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? Yes No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes No
0 NO.yiolatiOnSY)r deficiencies were noted during this.visit. You.wiliieceive nafurtlier.
correspotideitce about this:visit:
b) CX.-E
Ll9e_ a�vF�� e-�
s c,(�`W\cam %+c C7�� \ t s \� . t � (V_J
tS c �s\�e'7� I aYd�L GW lS t� (R�lc�\ a`c\2st �l�nt 7/25/97 _

❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection
of
I Facility Number I
Date of Inspection I 9JZ5`/7
Time of Inspection :/'S 24 hr. (hh:mm)
E3 Registered 0 Certified [3 Applied for Permit 0 Permitted JE3 Not Operational I Date Last Operated
FarmName: ...............t�`i............... r"Vll.............................................................................. County:..... INA........................................ .......................
.............- 1
OwnerName: ........... .Q\\.Ut:�l1(rS...........I W/fM.............................................................. Phone No:.L94...1.11-.�iq................................................
Facility Contact: .........UDVgI(tS.........._�ASdCtI_z..................... Title: ........151s?fuY.........p............................. Phone No: �41UZ5$'$�.�Lq.............
\lailittgAddress: ..... �Z.I.�i....... VXk!1p...:S�O.PY .......:.................................... ..... 92V)Af.I�../.I.N]........................................ .. g$�8.......
OnsiteRepresentative: ..._ Q!i p-i..._.b0.C��e,{hc........................._............................... Integrator: ..... I.G14OS.bore....._...............................................
Certified Operator: ........ &.. ......._ft........ .1 Nk9eet............................................ Operator Certification Number, ..... (.33.I.Z.....................
Location of Farm:
Latitude Longitude 11 • ©` ®"
Swine Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Number of Lagoons Holding Ponds
General
Design Current Design., Current..
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Total SSLW I 7b
Subsurface Drains Present IJU Lagoon Area
No Liquid Waste
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 clischarge 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 01 No
❑ Yes JZ No
❑ Yes ® No
❑ Yes IR No
❑ Yes ® No
❑ Yes ® No -
❑Yes [ZNo
❑ Yes 91}No
❑ Yes Jallo
❑ Yes 91 No
Continued on back

. Eacili;y Number: 3l — 211
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
Wo
Structures (Lattoons.11oldine Ponds, Flush Pits. etc.)
-
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
0 No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier:.................+...............................................................................................................................................................
...................................
Freeboard (ft): 3 • `
.......................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
I,9No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
IM No
12.
Do any of the structures need maintenance/improvement?
SYes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
( No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ............ b'f....... H�y.........................................................................._SM P... VG.U/.�..................................................
......................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
O 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
[Z No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
91 No
22.
Does record keeping need improvement?
UYes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
-❑ Yes
P 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
1l No
No.violations or deficiencies were noted during this.visit..You'will receive no further
correspondence about this -visit..',
any
12. San, afG:S an 16-5ao„ W4II5
-s6vtj Wt reseeded.
i—cjooN
&411S SN1OU�p bf mowed.
zspra,.� t^tCor k -S60Id toe
YtP{ la+ 'Spmy
raairus
J2.``
and �eOylulbev-s "look niyh,
t)�O W &w4ea1l(45is qhi)
win rri�Xf;on INwll'S
ihoA
be 4% cer}iltcj 11/ah.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 77A. A - /;{AL _ Date:

•
Farm Name/Owns
Mailing Address:
County: z�.;
Site Requires Immediate Attention:
Facility No. 3/—Al
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD C/wr' )
DATE: , 1995 7 (< f—YA 4A-14,
Time: /0 -36 /S�Lgvi l/C, tie
-S 7Ot—
Integrator. Phone:19/9) 77t-3/30
On Site Representative: F_^,Falicr> Phone:
Physical Address/Location: NF ('j2 i 9-0 y A�e�j'X 12
-��-
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: �2 04du `y Number of Animals on Site: " 32 ao
DEM Certification Number: ACE DEM_Certification Number: ACNEW
Latitude: 3u ° S 3' i t ^ Longitude:2"Z" V 1' y _5' " Elevation:- Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: _Ft. _0 Inches
• Was any seepage observed from the lagoon(s)? Yes oa Was any erosion observed?(f�r No
Is adequate land available for spray? V or No Is the cover crop adequate? M or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Y,0or No
100 Feet from Wells? -je or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
•
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or I'& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: _nnieR s,pvs% ' hN nvllno 1. ..�tt A.on Jr _k
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.