310232_INSPECTIONS_20171231

AM
NORTH CAROLINA
Department of Environmental Qua!
F)

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
of DSWC review
Date of Inspection n 91
Facility Number 3 ��Ye�_s•
Time of Inspection In$ 24 hr. (hh:mm)
17 Registered ® Certified ❑ Applied for Permit 17 Permitted i] Not Operational I Date Last Operated: ..........................
Farm Nantes .ilv_�.. .... ..+. �d........................................................................ County: ... 1-II.T..1 r.r.................................... W.I.&D.....
Owner Name:.tlo. Sa e...s�..kA-J n.r........k +_vv....................................... Phone No:. [4.1.0.} &S.'..5�. �..9 f..91.R.�Z B. ar.....S2-6 1
FacilityContact: .............................................................................. Title:................................................................ Phone No:.....................................................
Mailing Address:.... ..1....... .:'{..P.r...C.fS.....✓..S;..R,.k.......�'.W........................ ...................................... ..Z.�. .�.p...
Onsite Representative:.... rn.h..........f.%L.................................................... Integrator:....1:._S.S..�a..q................................................
Certified Operator:... ,:.1..a_ ..d, ...A..- ............. ..1-'+!..r.._ -.4 ................................ Operator Certification Number, .....I ... I.C. S._P............
Latitude =•='=" Longitude =•='=11
•' "" * f Design, ` .Current,
`Design , : Current „� Des "Current .
Swine "''Capacity Population
Poultry Capacity ,1'opulatioti Cattle _ Capacity, -Population .
❑ Wean to Feeder
10 Layer I airy
Feeder to Finish 2 9 H t)
ILJNon-Layer , ❑ Non Dauy
f
❑ Farrow to Wean
" _ '=. > r ,^ ' .. �.�n�
..
❑ Other I 4'
Total Design Capacity
❑ Farrow to Feeder
❑ Farrow to Finish
Z 9 H 0
��
'+
Y r�
�_. = Total SSLW;,
❑ Gilts
„
3 9 6 , Y 0 0
ElBoais
_ . r
Number of Lagoons / Iioidini Ponds ❑ Subsurface Drains Present 1101,agoonArea 10 Spray Field Area
d �-
�,
_�- - -- __
❑ No Liyuid Waste Manageemm ent System,.° i
} ,y
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any pan of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
SYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Continued on back

I
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaEoons,Holding Ponds, Flush Pits, etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft):
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application -
14. Is there physical evidence of over application? '
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
❑ Yes
❑ No
❑ Yes
❑ No
Structure 5 Structure 6
................................................................
.................................................................
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violati4m-or deftdeiwks.wem hotedduring this;visit: You'-.0H ieceive no ftirther.
correspotidettce about this:visit
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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�J
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: p,_,�(sp�,a ,� y_ _ _ _ ,�,,, Date:

W.
Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspection hi IL 1471
Facility Number
Time of Inspection = 2 Oj 24 hr. (hh:mm)
Megistered ®Certified O Applied for Permit 0 Permitted 1E3 Not Operational I Date fast Operated: ..............
Farm Name: .14v.r.d.t�.._Ep.-.x..rx:a_5................................................................... County:.. I2..u.�x�.t..ra................................. W.I.. A...
n............� ........................................ Phone No:. 9..1.A. _ ?.HS..... Owner Name:pa.u.acla.S..L�.M.i.l.ii.n ...�.v i�L
FacilityContact:................................................................................ Title:................................................................ Phone No:...................................................
Mailing Address: ...1.1.1......Cj x.t.st....... .Y...t.g._ ..... &a.&I................................................... ..4.>..`�..LL..
Onsite Representative:..I.),�.u.5.1.a.S... &.... .A! .11s......I-L.rt... i. Integrator:.... .r..t'.b..':n--I.................................................
Certified Operator:..S.1.e:.1.d.........P................ .....+!.xs. i ?ram........................... Operator Certification NNumber;..... 1_q...b...ra.. ............
Location of Farm:
Latitude �• =1 =11 Longitude E-1-2710 F 7-4-Cl, ©,,
Design'-'- .Current Designs zt urrent
Design Current
•Svcme b,-
,Capacity ;Population, Poultry, Capacity„Population Cattle„ „ ?Capacity
Populatioq.
„ .
1HLayer ❑Dairy
❑ Wean to Feeder
Z9 , '- ❑ Non -Layer ❑Non -Dairy
Feeder to Finish
,
�.
❑ Farrow to Wean
-g
�_
'❑ Other
Total Design Capacity"}
Z 9 t)
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
a
Total SSLW
❑ soars
Number of Lagoons 1 Holding Ponds- ❑Subsurface Drains Present ❑Lagoon Area IDSpray Field Area l
;
J❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge ori-inated 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 gaUmin?
d. Does discharge bypass a lagoon system'! (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
&Yes
[I No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Continued on back

Facility Number: 3 1 —
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
❑ No
Structures (La2oons.Holdinp Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier:...................................................................................................................................................................................................................
Freeboard(ft):.......................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
❑ No
11.
-Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
❑ 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.....................................................................................................................................................................................................................................
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
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
❑ No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
22.
Does record keeping need improvement?
❑ Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
No.violitioits-or deficiencies wlarle noted during this.visit..You"will reeeive ito fdrtlier
correspondence about this visit.
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w a i
7/25/97
Re\iewer/Inspector Name
Reviewer/Inspector Signature. Q,,,�,L 0A_ 1 V�l hjLy M , h Date:

NORTH CAROLINA
Department of Environmental Qual
91

-t?-17
for Visit ,0 Routine
0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit Arrival Time: yp Departure Time: County:
Farm Name: kl /' j4�i1---S Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: % ' 'b5o Pt( r✓ e4-r-- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Da Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
lh. r
Layers
Design
Ca aci
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I I Beef Brood Cow
Other
OtherI I
-TurkeyPcults
Turke s
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?
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes No ❑ NA ❑ NE
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) ❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes [:]No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Date of Inspection:� 3/ —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No A
❑ NE,
a. If yes, is waste level into the structural freeboard?
❑ Yes
Io Q NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No A
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment three otify 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 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑Yes 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): I3"rt5', Gtrl'-n
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑Yes No ❑ NA ❑ NE
d �
acres etermtnatron.
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
❑ VX0
❑ 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
ZNA
❑ 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 21412015 Continued

ti
Fecilit' Number: ,. j— Date of Inspection: .2- 2 -/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a 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 N NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[:]No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
�WJ444,13 ®Rpsr "4r4 1=/LOB, 7C-// SpecZa1.5�- 13;i1v( 140rti57LOP/
Reviewer/Inspector Name:
Phone: �/ / '74 I (1,Z 00
Reviewer/Inspector Signature: /t $ 4gie Z/w Q-(Date:
Page 3 of 3 21412015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 �y Arrival Time: /Qm Departure Time: J00 County.
Farm Name: lAu.nn-EV FA (I-M11S Owner Email:
Owner Name: �OtnC� t S 1 �l�,j t T� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
SS
Title:
104h L IaL A[rC R
Phone:
Integrator:
g014
Certification Number:
Certification Number:
Latitude: Longitude:
Region:
19[950
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Li Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
9 Y
OD
D4+ P,oulh.
I Layers
Design
Ga aci
Current
P.o P.
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
INW-1her
NJ Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impactsand 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 IJU No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes 9No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Condnued

Facili Number: jDate of Inspection* / /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes i777❑"''1111 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 1� No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 Apmlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
J�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application
Outside of Approved Area
,
12. Crop Type(s): C-43q- l W Hf ATS
13.SoilType(s): Vt-41ms 6OI.DSe>� 1—O6LE-5 JU/y
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists ❑Design 0 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
❑ W e Transfers
0 Weather Code
Q
Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections
❑ Sludge Survey
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - `j Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
�(
❑ Yes h( I No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
t�
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?
u
❑ Yes I YI 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 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
501L -16-FOLT 10/3/Ia
W.A.
Sc uOG& SU(ZVE� g - a -13
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ��� //(7 3�
Date:
21412014

Reason for Visit: ZRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other �0 Denied Access
Date of Visit: - I-/3_ Arrival Time: Departure Timer County: ,{Jp�') Region: '✓/�
Farm Name: 6 r"Zj y yy�' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: 1,6vA U
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Jt �1a1!`.7
Swine
Wean to Finish -
Design Gucrent
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -Layer
Da Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1)r. P,oultr.
Layers
Design
Ga aci
Current
P,o .
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
NJ Other I
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 VfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No
❑ Yes m No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili `Number: jDate of Inspection:
—)3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
ONo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�' o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
4� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�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
PrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C�'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�TNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
PIN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[7No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
16' No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ZfNo
❑ 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
VINo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
6 No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ej No
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1
Facili umber:
Date of Inspection: 5-1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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?
�[ No ❑ NA ❑ NE
I/INo ❑ NA ❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes [;� No
❑ Yes O� No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: Phone: 0�J�,��
Reviewer/Inspector Signature: fl/VwDate:
Page 3 of 3 21412011

Type of Visit:
Wempliance 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 0 Denied Access
Date of Visit: xt y,7 t Arrival Time: `w Departure Time:® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �Qk� `'ywJ %C—_2
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Feeder to Finish
6
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oul_
Layers
Ca aci
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other —TurkeyPuults
01 Other
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes O'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No
❑ Yes No
❑ Yes �7TMj�No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 21412011 Continued

Facility Number: Date of Inspection:
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
/
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑NA ❑NE
❑NA ❑NE
Structure 5 Structure 6
[:]Yes �kNo ❑ NA ❑ NE
❑ Yes I y1 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )1 No ❑ NA ❑ NE
maintenance or improvement? /`''�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C-Qq—A( w►iaT— S 9
13. Soil Type(s): K(I//)/S (':�4 ot. G5tS-O(lC7
14. Do the receiving crops differ from those designated in the CAWMP?.
❑ Yes
RNo
❑ 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
ANo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
f2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑YeNo
a
❑ NA
❑ NE
the appropriate box.
❑o WUP ❑Checklists QDesign 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
© Waste Application Q Weekly Freeboard ❑r Waste Analysis ❑+ Soil Analysis ❑ W, to Transfers Q Weather Code
❑ Rainfall ❑ Stocking Q Crop Yield ❑� 120 Minute Inspections Q Monthly and V Rainfall inspections Q 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

FaciH ty Number: Ts T1 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I XI No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑{ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No I p NA ❑ NE
O 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
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.
--ElY s
,,,,,��..........{{{{
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
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
LN
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
W•pl­-
���u(�aA;roN b�Uf—E dk.-,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /p16'�'L%-T}�
Date:
21412011

Type of Visit: Compliance 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 0 Denied Access
Date of Visit: 0 i' / Arrival Time: Departure Time: County: '1 u', ?(..//V
Farm Name: l \ (,17V7&2 6�_1q (ZM S Owner Email:
Region:
Owner Name: ( LAS
ACA t(7GR
Phone:
1
Mailing Address: 3 11 CU l
(J
— —SS C jL F�
� � LC P CE
���pp�
ANC d0 L4(J0 tD
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative:
/ �J U C,LAS �Ak VTEV_ Integrator:
Certified Operator: L10�,� � . �T E (- Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
19650
Swine
Wean [o Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
0
3000
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oulh.
Layers
Design
Ca aci
Current
P,o ,
I
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
IBeef
Brood Cow
Other
01 Other
Turke s
Turke Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 X No ❑ NA ❑ NE
[—]Yes ❑ No
[—]Yes [—]No
❑ Yes ❑ No
❑ Yes No
❑ Yes I
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: Date of Inspection: Q
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: 00AI
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3S
❑ 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.)
❑ Yes �4 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
—
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application L
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 K I 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): C 0" w HE4-T S
13. Soil Type(s): FOQ�70!✓�G�5�kr J
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,��M///,,, No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes %.No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ; No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
0 WUP ❑Checklists Q Design 0 Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑� ste Transfers Q Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections ❑ Monthly and 1" Rainfal Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 1, 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 21417011 Continued

Facili umber: - 3
Date of Inspection: / O / /
24. Did the facility fail to calibrate waste application equipment as required by the pennit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
No ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ 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?
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?
Jse drawings of facility to better exi
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any YES answers and/or
situations (use additional
aC) I �
as
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No
❑ Yes TTW'' No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Phone: 6 I1 U 'W OV )
Date:
21412011

'Type of Visit 0 Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O-Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival(Tiime: Lq� Departure Time: County: Ll Region:
Farm Name: p Owner Email: Q t�
Owner Name: CtiiLA S NALkNTc1� (� \Phho'ne: 9)C>—� 1aO5—�5�/4) 7/—
Mailing Address: �I1 CUpi1C.��S CeEE� � b' .Ace- Ac r)6 (C(o
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: L� O41J 1:tAAiTFe.
Back-up Operator:
Location of Farm:
Phone No:
Integr tor:
Op�ttoorlCoertifcation Number: 'IW9�
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = , =
a
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C•apacgy Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish �/�
❑ DairyHeifer
Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pallets
❑ Beef Brood Co
❑ Turkeys
KO-ther
❑ Other
❑ Turkey Poults
❑ 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 �No ❑ NA [I NE
❑ Yes /!❑\No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

F,acility.,Number: j — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �Io
❑ 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 row
Spillway?:
C
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
,
❑ Yes KJ 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
❑ Yes }y No
El NA
❑ NE
through a waste management or closure plan?
,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stucmres 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 )1 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?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soiltype(s) LINS �lp�jig(t�OQAy�-nQFS7D�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
El NA
El NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
llrr No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ET No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
"E�No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
E[N- o
❑ NA
❑ NE
Comments (refer to question #): Explain any, YES answers and/or:any recommendations or any-otber comments
rr
Use drawings of facility to betterexplain situations. fuse additionalpages as necessary): - 4
Reviewer/Inspector Name F—M 6w S
Phone: C%/b -i�tii 3
Reviewer/Inspector Signature:
Date: C�
Page 2 of 3 12128104 Continued

•Facilitj•Number: / — Date of Inspection g }
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 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes gNo
❑ Yes ANo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 0� No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ yaste Transfers ❑�ual Certification
0 Rainfall [I Stocking El Crop Yield El 120 Minute Inspections � Monthly and 1/Rain Inspections ❑� Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes No ElNA ❑ NE
❑ Yes9No
No El ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes A No ❑ NA ❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
,,,��g{{{No
p�1 No
❑ NA
❑ NE
❑ Yes
% No
❑ NA
❑ NE
❑ Yes
t�No
❑ NA
❑ NE
❑ Yes
-No
❑ NA
❑ NE
Additional -Comments and/or Drawings: a ."
w'A•
(�gQFi716Jv ��` Oki/
Page 3 of 3
12129104

Type of Visit ftCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �f Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I N Arrival Time: rr Departure Time: County: l� Region:
Farm Name: �AuNTe(z FRfRmS Owner Email:
Owner Name: ��uC L� S VA tAh/7C'9- n , Phone: 9)o- „nn t85- 511 7p
Mailing Address: + I I F-SS C Ze C f, l.k-\sA U_Aei= . Nc a9LMo b
Physical Address:
Facility Contact: \ Title:
Onsite Representative: �Oti � 1`1 SAN % &F
Certified Operator: U o N Q `i� _ )Aw/t! % eg-
Back-up Operator:
Location of Farm:
Latitude: n°
Phone No:
Integrator:
Operator Certification Number: 19 to 5 0
Back-up Certification Number:
Longitude: [=°=, ="
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
1A No
❑ NA
❑ NE
❑ Yes
(A. No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

r
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
'Structure I-, Structure 2 Structure 3 Structure 4
Identifier: t_.F�1�ol.]Io
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a9
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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes �( No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'q(.I No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) ' \
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) ( QqW W NER T
13.
Soil type(s) "INS 6OL-0-39ce-C.) J709-6,5TOW
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Idl 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 acre determination?[:]Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
%No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments("referto queshonl#)�Egpbun anyt2YEStanswe`rsaand/or any recommendations or any other comments.
"Usesdrawings of facthty+"to better explain sttuattons (use addthonal'pagesras necessary):
-x:c.•..�Pl?';.; T. r�`:#�-
w.A
wq/0" D�'Ac�nti cs�o�S �c�oD�
to
1 % lcar I.5
Reviewer/Inspector NameDqjA—Mil< — S Phone:
Reviewer/inspector Signature: QAT4i Date: ��009
Page 2 of 3 12128104 Continued

Facility Number: ) — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes LXI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA W MP readily available? If yes, check ❑ Yes PO'No ❑ NA ❑ NE
the appropirate box. ❑ WUP 0 Checklists ❑ Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis El/as te Transfers /nnual Certification
❑ Rainfall ❑ Stocking El Crop Yield ❑ 120 Minute Inspections 0 Monthly and I" Rain Inspections 0 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 CAW MP?
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
ElNE
ElYes
[ No
❑ NA
❑ NE
❑ Yes
o
ElNA
❑ NE
ElYes
jNo
ElNA
❑ NE
ElYeso
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
1 No
❑ NA
❑ NE
❑ Yes
Pq No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes fin No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
lAdditional Comments and/or Drawings: I
Page 3 of 3 12128104

-.,._, r� n 0 Division of Water Quality ✓
Facility Number 3 p/ 3d 0 Division of Soil and Water Conservation
— --'---- -.._ 0 Other Agency
(Type of Visit Q%compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L.S�J�_l�4J Arrival Time: 3� Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: w Title:
OnsiteRepresentative: IJN70—
Certified Operator: Ua HT%(Z
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Region:
Operator Certification Number: 0
Back-up Certification Number:
Latitude: =o =, =,, Longitude: =° =
Design 'Current Design Current
Swine_ Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I ❑ La er
❑ Wean to Feeder I _ 11 ❑ Non -Layer
Other
❑ Other
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 Heifer
❑ 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?
Page 1 of 3
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
IV No
❑ NA
❑ NE
❑ Yes
[XNo
❑ NA
❑ NE
12128104 Continued

Flcility Number: 31 — Date of Inspection f�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes JXNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LACOGIV
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in): N • S
Observed Freeboard (in): 3 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [ No
❑ NA
El
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ty� 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 ;9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 Jallo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes )� No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 4 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RrNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
K No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ 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):
Faa.,,k 15 iN 6iZE4T57b�.
Reviewer/InspectorName ,4^f j Phone:
Reviewer/Inspector Signature: Date: (D
12128104 Continued

r Facility Number: '3 — 3 Date of Inspection �O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5ANo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other �t
21. Does record keeping need improvement? If yes, check the appropriate box below. [IYes ICI No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and N Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes llI No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,fNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Er No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
oorryyyy1119
IL t 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
[ No
❑ NA
❑ NE
Page 3 of 3 12128104

I
• � Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency I/
Type of Visit .0 Compliance 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 Acces/s,/ L
Date of Visit: 7 E% Arrival Time: Departure Ti e: �!�S County: U�GT.✓ Region:
Farm Name: aGG L7fh% , �l.INI')5� Owner Email:
Owner Name: IV
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: z
Certified Operator: L��Do ,0
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ ---- jo = = Longitude: =o =,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
E]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 Populatil
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 5
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ld No ElNA ElNE
❑ Yes �No ❑ NA El
12128104 Continued

j
Facility Number:3/—Z371 Date of Inspection If'/ZO/o 7J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No El NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yel No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
,} Identifier:
Spillway?: _leoo
Designed Freeboard (in): /9 Zjr
Observed Freeboard (in): 217 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,,,___,,,(((
6. Are there structures on -site which are not properly addressed and/or managed El Yes J[I No [I NA El 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 �[I No El NA El NE
8. Do any of the smrm
ctures lack adequate markers as required by the peit? El Yes �No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes PN o ❑ NA ❑ NE
maintenance or improvement? /
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
ElNA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) /yNo
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
ElOutside of Acc ptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12.
Crop type(s) / S4 _ /
13.
Soil type(s)
14.
Do the receiving crops iffer from those designated in the CAWMP? ❑ Yes 0 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes XNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yesNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? El Yes ZNo
❑ NA ❑ 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: j�L/t
Date: _
12128104

Facility Number: — Date of InspectionI_ fJZULD $
Required Records & Documents ,,.,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? JCJ Yes fflfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check /❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain minbreakers 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?
7
33. Does facility require a follow-up visit by same agency?
Comments and/or
��/3/0& Q50ZG /657 j,"
/17) /N�'/�Q 01� l2 !►/41Lj � rnz7
- S roP Sa . 44/ . I 1 %gay =` -7 V
- 6AI �Oalnp jamlo
to Oe7p-_0646<2 3lj
❑ Yes '4No
❑ Yes PNo
❑ Yes o
ElYes tNo
❑ Yes zfl
❑ Yes !!!!!! VJ No
❑NA El NE
❑NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
❑ Yes ILJNo El NA El NE
Eld Yes / No ❑ NA ❑ NE
❑ Yes idNo ❑ NA ❑ NE
❑ Yes XNo
❑ Yes No
❑ Yes UNo
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
FOn �c%/E LS
12128104

Facility Number
Division of Water Quality
Division of Soil and Water Conservation
Other Agency
IType of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ��� Departure ime: Zr ountyi
Farm Name: TYL/� /->O,J !/.t/>F�J Owner Email:
Owner Name: &V_:-f& /c4if'zLS Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title.
Onsite Representative: 'kV We:, L N7�—iL
Certified Operator.
Back-up Operator: ^.'t
one No:
Integrator:,
Operator Certification Number:
Back-up Certification Number:
Region: 4t2
Location of Farm: Latitude: M U = [� « Longitude: [� o =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes [:]No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes )dNo
❑ NA
❑ NE
❑ Yes )ZNo
❑ NA
❑ NE
12128104 Continued

f
Facility Number* — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: A"
Spillway?: 11 V
Designed Freeboard (in): 9-5
Observed Freeboard (in): Z5
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes oNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes oNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes '( No ❑ NA ❑ NE
8. Do any of the stucmres lack adequate markers as required by the permit? ❑ Yes l U No ❑ NA [3 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? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0"No ❑ NA ❑ NE
maintenance/improvement? ���(((
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I/J 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
ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?.
❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
(�No
❑ NA
❑ NE
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):
Zi) �P �s>� �.✓y �o�nmcQcyyc �/vz L�z��. 0,�•`p ' �� co
_
n�FEP
Reviewer/Inspector Name Phone:
Re viewer/Inspector Signature% Date: 5 O
Page 2 of 3 12128104 Continued

Facility Number: ! —'l Date of Inspection �LJ3L�
Required Records & Documents ���((( El19. Did the facility fail to have Certificate of Coverage & Permit readily available? El( Yes ,,,I___,,,J(((No NA [:3 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El /I[I No ElNA ❑ NE
the appropriate box. El❑ ❑ Design El El
WUP Checklists /
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 Transfe ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ,ONo ❑ NA ❑ NE
ElVJ Yes No ❑ NA ❑ NE
❑ Yes IQ No ❑ NA ❑ NE
❑ Yes J�No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
Cl Yes
�No
El NA
El NE
❑ Yes
LLI No
/m
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
l�No
XNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
;dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
A/O % �: l�Uf2� �� �/fi2�rl -�s �G^ �c �/ (�t/�'q z,✓fD..
Hw
Page 3 of 3 12128.104

Type of Visit 95 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /0 Arrival Time: i Departure Time: County:
Farm Name: WA%7EC �J�d/�►/�l1�'S Owner Email:
Owner Name: ' /'awa/_/45 be // eG70a/��tlT �/Z� Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Latitude:
No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�� ❑ Non -La et
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?
Region:
" Longitude: [----]c 0 0
Design Current
Cattle Capacity Population
Number of Structures: Fj I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes o No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

J_
Facility Number-7
/ —Z 32 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?: �1%
Designed Freeboard (in): /Q,7
Observed Freeboard (in): Z9
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 m No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ?I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require' ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Yes $PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑/PAN ElPAN > 10% or 10 Ibs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
VJ 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 Z No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes VNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ yes IGI No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes JgNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes R/No
❑ NA
❑ NE
(1,45 �al ?/o8). C*-elknP Zr5515
��QG1�lZOA7NODw �lJQ f 0.2n/ 45
Reviewer/Inspector Name r �T Phone:
Reviewer/Inspector Signature: Date: 7/ p
/O/Lg/ds 12128104 Continued

. i-,.
Facility Number: — Date of Inspection O /
Reauired Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,L�dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ld"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 P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes X,No El NA ❑ 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 V No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA XNE
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
El NA
El NE
El Yes
X,,,No
/I/J
❑ NA
El NE
El Yes
__(((
No
/to
El NA
El NE
El Yes
No
❑ NA
❑ NE
❑ Yes
[/No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
Ad,� Wdrttonan../or r., gs :- 3" }tp .:: we ti.e`• Y�."r t MY'�4 a�P' ..r� $
l. Comments adDawin
`
nn /�iglt✓/n Loo`f�p �OaD /C�..CoaDS �/�1
f/iJil�lrcG
12128104

Type of Visit (,C--//ompliance Inspection O Operation Review O lagoon Evaluation
(Reason for
�Visit p'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
' Facility Number late of Visit: Ti..:
0 Not Operational 0 Below Threshold
Permitted Certified [3 Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: __L9R 6AAMS County: D.*LZJJ
Owner Name:
Mailing Address:
Phone No:
Facility Contact: __ _ Title:.__ Phone No:
Onsite Representative: v��_L+j Integrator -
Certified Operator:-------.-.. _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =1 =11 Longitude =• =' =K
_Desgt cnrrmt ' Daestgn Gurreat I)e9gri Cnrimt
Swine _Ca o uhtton;_y
ao
Po�tr9
:
Ca Po Mahon : _ e Ca as Po notation _
der:
❑Layer
Dairy
tish
O
Z
A Non -Layer
Non -Dairy
ean
OtherinishTotal
eeder
Farrow
DeslgnC
- Total SSL�1'
:r
Discharttes & Stream Impacts —/
1. Is any discharge observed from any part of the operation? ❑ Yes D&O
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaLlmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 7140
2. Isthere evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 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): 23
12112103 Continued

Facility Nr, nber: J — 2 32 Date of Inspection
5.
Ate there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
24No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
No
closure plan?
(H 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 maintenancerimprovement?
❑ Yes
❑ No/
8.
Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes
N/o�
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
�❑
p]Qo
elevation markings?
Waste Application
10.
Are there any buffers that need maintenanceftmprovement?
❑ Yes
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
_ o///o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload []Frozen Ground ❑ Copper and/or Zinc
12.
Crop type GSW
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
y'
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
,�(
b) Does the facility need a wettable acre determination?
❑ Yes
Fo
c) This facility is pended for a wettable acre determination?
❑ Yes
Yes
No
15.
Does the receiving crop need improvement?
❑
[a
16.
Is there a lack of adequate waste application equipment?
❑ Yes
L� �o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑Yes I Now
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes &401
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ,❑'No
Air Quality representative immediately.
a .m—e f
t;AIDmin15 (I'eflr t0 QneShOII !) Esplsu� YES'answers and/or aDy ieoommendaho R,or any DthC.OIDmtIItS.. �,
Use drawings a1 faaGty to better e=plam stma6oas {use addr6onsl'p®8esasmay) �� ❑ Feld Copy ❑ Fiaall Notes
—'�£v4
,._
/'
nit;tJ alter WIBC C7 CSW b
KCEP LoP� of ANNvtiL -09w1
�An4A stJ Gap, 514APS,
C
Reviewer/InspectorName a
Reviewer/Inspector Signature: Date: tl a
12112103 1 Continued

Facility lyumber: 31 —23 Date of Inspection l6 0
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes QNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (iet WUP, checklists, design, maps, etc.) ❑ Yes 2<0'
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Q O
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes [
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application) ❑ Yes o/
27. Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative? ❑ Yes E- O1`Io
28. Does facility require a follow-up visit by same agency? ❑ Yes CQJNN/
29. Ware any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) aTes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Cvo
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑X6­
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes 0140
34. Did the facility fail to calibrate waste application equipment? ❑ Yes —N/o
J 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
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
onsiCorandlorDraarng� .��
AL
12112103

Facility Number 31 232 Date of Visit: 4/18/2002 Time: 13:00
O Not Operational Q Below Threshold
® Permitted ®Certified 0 Conditionally Certified E3 Registered Date Last Operated or Above Threshold: . .. .. ........
Farm Name: Hurttes.k'a[ms........................................................................ County:[?vuli0.------------------- -................ )?YMQ--•---
Owner Name: Douglas_&M9jDn______ Httote[-----------•-•-_-•-.-------- Phone No:
Mailing Address:.7.1.t.CxR[ess..C[eek..[iaad................................................................. W..ellarg...N.C........................................................... Z8.466..............
FacilityContact: ...........................................................Title:............................................... Phone No: ......................................
OnsiteRepresentative: QQOg.Hunlfl[Integrator: PleStageFx[uts...........................
Certified Operator: LiQyd.D................................. Huntex .............................................. Operator Certification Number: 19.6,50.............................
Location of Farm:
Northwest of Cypress Creek. On North side of SR 1828 approx. 2.5 miles Southeast of SR 1816.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 46 38 Longitude 77 • 46 18
Design
—Current - - Design Current =
- Design Current
Swine - -- - Ca aci
-:=Po ulation Poultry_ - Ca aci -Po ulation Cattle -
-capacityPopulation
❑ Layer ❑Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity-
- 2,940
- Total SS_LW '
396,900
Number of Lagoons.
0 IN Subsurface Drains Present ❑ Lagoon Area ®Spray Field Area
Holding Ponds / Solid Traps',0
❑ No Liquid Waste Management System
;
❑
Wean to Feeder
®
Feeder to Finish
2940
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ®No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ 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:._._.. - .1. - .....:................------ --------------------------------........................................----- --------------------------
Freeboard (inches): 39

vaiwiw
Facility Number: 31-232
Date of Inspection 4/18/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADDlication
wnrueueu
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ® PAN ❑ Hydraulic Overload ® Yes ❑ No
12. Crop type Corn, Soybeans, Wheat
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?
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?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
® Yes ❑ No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ❑ No
® Yes ❑ No
E3 . No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer to uestion - (_ q _ #/): Explain any YES answers and/orahy recommendations or,any other comments
— -
Use drawings of facility to better ezplam sduatrons (use additional pages as necessary) : ❑Field Copy ❑Final Notes
11. Overapplication of Plant Available Nitrogen occurred on the 2001-2002 wheat crop; this occurred on Tract 7948 Field 1 pull 4 in
which 142.6 lbs PAN/acre was applied to the crop while the waste utilization plan allows only 120 lbs PAN/acre.
_
14. It appears that there are two different irrigation designs for the facility. I am unclear as to which one should be used as they appear in
ave the same date. The correct design needs to be confirmed, the waste plan needs to be written accordingly, the applications need to be
made according to the design, and the records need to be kept accordingly. In reviewing the irrigation design, it appears that the
application area of hydrant 1 sprays over a ditch; the design needs to be modified to prevent waste being sprayed into the ditch. Also, on
pull 2 it appears that the irrigation design is calling for a bridge to be installed to pull the traveling gun cart over; this bridge needs to be
installed and the pull made accordingly or the design needs to be modified to eliminate the need for the bridge while continued
Reviewer/Inspector Name Stonewall Mathis ��—
Reviewer/Inspector Signature: Date:

O5103101
Continued
Facility Number: 31-232 Date of Inspection 4/IS/2002
J
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
E] 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
®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
®No
31.
Do the animals feed storage bins fail to have appropriate cover?
Yes
E]No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
©No
4. preventing waste being sprayed into the ditch. Also, the irrigation design shows parts of pulls 3,6,14,15, and 18 having arc patterns
oss than 180 degrees; the hydraulic loading rate needs to be reviewed on these pulls to ensure that hydraulic overloading will not occur
ue to the reduced arc angle; any necessary modifications are to be made to the design, waste utilization plan, applications in the field,
application record keeping.
7. The Certificate of Coverage and General Permit are not available for inspection and they need to be.
9. Mr. Hunter used 140 as the beginning PAN allowance on the IRR-2's for wheat but should have used 120 as provided in the waste
ization plan.
Mr. Hunter has been determining the IRR-2 beginning PAN allowance by multiplying the PAN rate provided in the waste plan by
number of acres in the pull; he should not be doing this, but should rather be simply using the rate on the IRR-2's as it is provided in
waste plan. This in part appears to have contributed to the noted overapplication to the wheat crop. Mr. Hunter and I discussed this
I showed him the correct way to keep the IRR-2's. W. Hunter indicated that he understood the correct way to keep the IRR-2's.
Mr. Hunter used 120 Ibs/acre as the beginning PAN allowance on the soybeans; the waste plan provides for 140 lbs/acre which
uld have been used.
Mr. Hunter needs to ensure that a waste analysis dated within 60 days of application events is used to calculate on the IRR-2's the
ogen applied.
Mr. Hunter needs to update his records after each application event; it had been indicated to me by Mr. Hunter during a telephone
versation that the records were not updated.
The owner and technical specialist need to sign and date the waste utilization plan.
During the inspection, the traveling gun was pulled out and prepared to spray in a manner not consistent with the irrigation design.
gun was pulled far out to the side of the desired traveling pattern provided by the irrigation design. Mr. Hunter needs to install targe
-kers for each of the pulls which allows those individuals pulling out the gun to have a target for which they are pulling the gun
,ard. Mr. Hunter should get technical assistance from the District office for this purpose.
Mr. Hunter is required to notify the DWQ regional office of overapplication of Plant Available Nitrogen.
Hunter should contact the Soil and Water District, County Cooperative Extension, his service company, and any qualified private
:ultants for any assistance they may be able to provide in any of these matters.

7.
Division of Water Quality
0 Division of Soil and Water Conseryatton-
-. Other Agency - -" -
Type of Visit 4nrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit,)Or"Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number .;'I 'L3 Z Date of Visit: Time: Printed on: 7/21/2000
PJ Not Operational Q Below Threshold
Permitted ❑ Certified Q Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ........................
Farm Name : ............_..TT.........1.........n.......f....I..........��...`..�.fr►5Count
V p I h'�...................................................... . ......._.r..........................................................
Owner Name:lin..........._.................... Phone No: .........
.............................. ................ ...........................
Facilitv Contact:
Mailing Address:
Title:
Phone No:
OnsiteRepresentative::Pi�1fq,S.+.nl'�� "41. Integrator:.,..r..1�.eS"�af1C
................................................_................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
lSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �•
Design Current Design Current Design Current
Capacity Population Poultry Capacity PopulationCattle
Po aatione;
- Wean to Feeder ❑Layer ❑ Dairy
Feeder [o Finish Z LI ❑ Non -Layer I[] Non
Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total "SSLW
_ n Number of Lagoons '. ,� j Subsurface Drains Presentj[❑ Lag� Area 10 Spray Field Area
HoMupt Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure.5
Identifier: .............../.......
Freehoard (inches): 2
5100
❑ Yes JXNo
[]Yes RfNo
❑ Yes No
h U
[]Yes XJ No
❑ Yes XNo
❑ Yes )2rNo
❑ Yes P(No
Structure 6
Continued on back

'acility'Number: ( —2 $2-. Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes VNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes..,KNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes j2TIo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
ZYes ❑ No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes XNo
11.
Is there evidence of over application? ❑ Excessive Ponding [IPAN ElHydraulic Overload
[IYes ❑ No
12.
Crop type Corn I Whe"rll) ayL? . t K S
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ONO
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes1KNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes ❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available? -
❑ Yes �lo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ YesNo
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 ONO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes No
(ie/ discharge, freeboard problems, over application)
❑ 0
23.
Did Reviewerfinspector fail to discuss review/inspection with on -site representative'?
❑ Yes XNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes XNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
•
• tVo•viblatioris:oe ileficie dia-9 were nbfed- during this:visit; - Ybu will-teceiye 06 fui Cher .: -
::
corres orideirce:ab66ithis visit::: .
Comments'(refer to question #): Explain any YES answers and/or any recommendations or any other comments + f _'>
Use drawings of facility to better explain situations. (rise additional pages as necessary): +
'4
q. F"ree6oa,-A r^ArkQr is 6rokchO6f• %4aVe-Freeb,,jed-fecorz* .rtkv-ke--'
p fe p') re/L av\A re4 proPe0 r
"1. SOii 4es}S slog1A be -ktkeh •For Gl.�i.f,eId it emelY -Aaa, i.T ne soi146sl
repor¢ fo - `J.OGtb- 'rea6oare( reGo,-d-r Ae4 4e /be kee4 mrt ct t&aek/y �ts;r
iL l ;iec i 46 be dvallable -Fa/ inSYC'C'fiot^;-f' c are r -/'en ay
kee. kecordw Sl ow 41,a he s/or�ay .nj ha,s' been demo stnrce 3/2s/ O.
Reviewer/Inspector Name Z—O h e Pm I l -%2l. is
Reviewer/Inspector Signature: _ •o _ _ Date: 5100

9
LI
Facility Number: 3' —23 Date of Inspection OI Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Oyes ❑ 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 O'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Pf"o
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,,ONo
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 O No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
AdditionalComments-and/orDrawings: - _-
5/00

t. E3Division of Soil and Water Conservation Operation Review:
[31Divisi of Soil and Water Conservation Compliance Inspection c
Division of Water Quality - Compliaric_e Inspection
[.Other:Agency-'Operaiion-Review
Routine 0 Com laint 0 Follow-u of DWQ ins ection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection ! 30 24 hr. (hh:mm)
Permitted PLCA
'ied 0 Conditionally Certified 0 Registered � Not O crational Date Last Operated:
..........__......----
Farm Name: ..l�..c.f,r �.Y_.k4^S County: (... .........
................ .... r'P.........
J�.....
Owner Name: ....... ......................._ �5............N::.7""..... Phone No:
FacilityContact: .............................................................................. Title:... ............................... Phone No:...................................................
MailingAddress: ......................................................................................................................................................... ........................
/ // / - S ..�.......... ..
Onsite Representatives 1 .. �.....0 %'1"(/................................. integrator:..... ......... .
r>!
Certified Operator: ................................................... .......................................... .................. Operator Certification Number:..........................................
Location of Farm:
..
Latitude =• =' =K Longitude =• =' ="
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
y
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer 1 1[] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes IX No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes []No
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes []No
c. If discharge is observed. what is the estimate( flow in-alhnin? _/VA -
d. Does discharge bypass a lagoon system? ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes DQ No
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes EX 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: 2 u
Frechoard (inches): ............._,J, .
1/6/99 Continued on back

acility Number: 5 1— Date of Inspection 1tl l fa 2.a Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? fie/ trees, severe erosion, ❑ Yes b4No
seepage, etc.)
& Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(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 X No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement'? ❑ Yes ❑ No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
[]Yes
❑ No
12.
Crop type M
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
i No
15.
Does the receiving crop need improvement?
❑ Yes
® No
\No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
q No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
fie/ 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
N No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
C4 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
%No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P No
24.
Does facility require a follow-up visit by same agency'?
❑ Yes
P No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Dj No
b viblatititis:ok- deficiencies -were b d-durifig. 4his:visit.'- Y:oit will receive tio: fui ther: :
ctirres otidence:aboutahis 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):
yw, Igo + k i. k�1�; ec.--4�-.- f'll'l1.oW5 yio- 'ID 54...t
T-k- dotty. -eve eflLr�e�l h7 ,cai _41 __ �+IP�dE cropC�i t7k r�r
W%n ij s� WwP C(u?S)j �1`Nye LDNte LL So l�L.� lJc��1e,.ov.V
Reviewer/Inspector Name r
Reviewer/Inspector Signature: Jc_= r t4A , / /, // 6/ Date:

acilitt Number. - Z Date of Inspection \ ZU b
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
Elpti Yes
,,,------!!! No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
CqNo
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
KNo
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
KNo
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
ERNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
KYes
❑ No
3/23/99

Facility Number 3/ ,Z3 Date of Inspection
Time of Inspection 11 24 hr. (hh: mm)
0 Permitted E3 Certified 0 Conditionally Certified E3 Registered 0 No[ O erational Date Last Operated: „____........--__..
Farm Name: .......j......�...�.......'11/.rt-f.e.r...�..!.�.�'YIS ............................... Cuuntv:.....�...✓ ...�
Owner Name:.......... LU t�A_ �Ci �3' �j "< Ad I- ...:<. o rl:l C'�..................... Phone No:.......................................................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: ..... .�1D..?Integrator: .........pr�7R..
............'................................................... .... .
Design Current. Design _ Current
Swine - Capacity Population Pond try _ .Capacity ..Population Cattle
❑ Wean to Feeder
10 Feeder to Finish
ZR
1 ZSG
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish -
❑ Gilts,
❑ Boars
-_ ❑ Other
-Total Design Capacity
Total SSLW
(Number of Lagoons � -- Subsurface Drains Present ❑ Lagoon Area Spray Field Area
--HoldirigPonds / Solid Traps ' ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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 gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure
Identifier: I
Freeboard(inches): ....... 2......................................................................................................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑Yes PjNo
❑ Yes 1Z No
n /<
❑ Yes NJNo
❑ Yes jd No
❑ Yes N No
❑ Yes ® No
Structure 6
[]Yes gJ No
Continued on back

Facility Number: =31 — 2,3,7 Date of Inspection li q
6„ Are t tere structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes jg No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? -
❑ Yes JN No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN -
❑ Yes Z No
12. Crop type Cow WhG"kI Se b rd
13. Do the receiving crops differ with those designated in de Certified Animal Waste Management Plan (CAWMP)?
❑ Yes N No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes !g No
b) Does the facility need a wettable acre determination?
❑ Yes (3 No
c) This facility is pended for a wettable acre determination?
❑ Yes Jg No
15. Does the receiving crop need improvement?
❑ Yes ®No
16. Is there a lack of adequate waste application equipment?
❑ Yes No
Required Records & Documents -
-
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes No
(ie/ WUP, checklists, design, maps, etc.)
19
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
lg Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ;5 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 ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 9 No
24. Does facility require a follow-up visit by same agency?
❑ Yes 21 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
¢ri:iieceseeneddutghi'itYwlic46no.frhe0'i•vioatiso+dgfcu•wrot• iitsv-oul•easr
comes otideitce:about:thisvisit::-:. .
Comments (refer to question #)* Explain any YES answers and/or any recommendations or any 6t6er.commeuts
Use drawings of facility -to better -explain situatious": (use additional pages as necessary-
ti kce�.i1 week/ �ice6eq.G9 rr,,4^o
19,'Farr.,cr Sko&Ilol 7'1'e
Nsg•ew &UeAAt keh.
•r,cr'44'�cd 0,7;^tow/ l✓as�e �l�Irst%�+f.cayf t�l4r, jeas -% be
ara
Reviewer/Inspector Name ( 7 ,. -3 Lo.i
Reviewer/Inspector Signature: �/ Date: 1 1'// b 9l
3/23/99

Facility Number: —232 Date of Inspection / )�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below A Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes A No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
9 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
X 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
f No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
,� Yes
❑ No
3/23/99

Division of Soil and Water Conservation [3 Other Agency g
Division of Water Quality g
Date of Inspection
Facility Number -
Time of Inspection 2-30 ?A hr. (hh:mm)
E3Registered MCertified ((Applied for Permit 0 Permitted JE3 Not Operational I Date Last Operated:
..........................
Farm Name:.......... t^d er.. .............................................................. County: ....
..."�.�..y........................1............................
Owner Name:... 0. 3.. ..... � ``....ll.S,.l. .................._.................. Phone No: ......_1 �0..... G..��._� 5 ••• 1
Facility Contact:
Mailing Address:
Onsite Represents
Certified Operato
Titles_
Phnne Nn-
r................................................... ............................................................. Operator Certification Number:.........................................
Locat' .. .n of arm
_GS....... �.............. .. .x.......... l'..?. ... ....... ........ .........�......... r...........................D
+�i.v:.....l..11.... L$.di...... ....k.5.... !.'1. .... .... .. ...._ :.._N-:.............................................................................................................
Latitude 0' 0' =" Longitude =• =' ="
Swine" Capacity Population Poultry -'Capacity Population Cattle Capacity Population,;
❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish ab ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean "
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
:Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
' ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
M No
2. Is any discharge observed from any part of the operation?
❑ Yes
e4 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
0 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
i(No
c. If discharge is observed, what is the estimated Flow in gal/min?
MA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
1%(No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
W No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[gNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
[g No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IgNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0 No
7/25/97

+aciGty Number. '1J � — a3a
8. -Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lasoons.11oldine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Identifier:
................ ..............
Freeboard(ft):...........
Structure 2 Structure 3
10. Is seepage observed from any of the structures?
❑ 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 runoff entering waters of the State, notify DWQ)
15. Crop type .....Cry.`.'.y .(!^! `1..1..5.................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violationsoi &ricieitdes.were'iiotedduring this:visit: You.witi receive ito lirthei-
corresp6ndence about this:visit.
�i pt-Z
�GL'Cc.�e-3
❑ Yes 0 No
❑ Yes % No
❑ Yes tq No
❑ Yes 14 No
❑ Yes 0 No
❑ Yes DI No
❑ Yes 14 No
❑ Yes t4 No
❑ Yes 19 No
❑ Yes O No
❑ Yes ONo
XYes ❑ No
❑ Yes gNo
❑ Yes q No
❑ Yes gNo
7/25/97

DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
149 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other 1
i Date of Inspection
Facility Number 3 Z Time of Inspection
I] Registered ® Certified E3 Applied for Permit 13 Permitted E3 Not Operational
FarmName:.... ?...h. .....f;z Y4...............................................................
Owner Name:.P►.V1.tt.s... ...........................................
Facility Contact:
Title:
24 hr. (hh:mm)
Date Last Operated:
County: .....V VT1A..n. ................................ Wi.. j..D..
Phone No: ... cn.l.p..._;A.5-:5.7..fff.........................
C 9102g9 -5Z6 I
Phone No:
Nlaihng Address: ..7..1..1....... L..y..P.r� dS........ ¢ ¢�' 1 ...................lh%lA.�.�.a G C y...< ..� ............................ _2.2....
Onsite Representative:..D.D.u.q.I./rti.... &... �.L An....17v.�. ter ............. Integrator: .... .Px-. _a...9...............................................
Certified Operator: .... (rl.O..y\.Jtl..... ............ .wi.r1.��1 ........................_.. Operator Certification Number....131.5.0 ...............
Location of Farm:
Latitude©* y T1, ®" Longitude F__'7__1• ®®1
Swine Capacity Population
❑ Wean to Feeder
KFeeder to Finish
7-9 q 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity. Population
❑ Layer I ❑ Dairy
❑ Non -Layer I ❑ Non -Dairy
❑ Other
Total Design Capacity 2 9 9 0
Total SSLW 39 C 900
Number of Lagoons / Holding Ponds J❑ Subsurface Drains Present J10 Lagoon Area ID Spray Field Area ( I
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2. 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 Surface Water? (If yes, notify DWQ)
❑ Yes
($No
c. If discharge is observed, what is the estimated Flow in gal/min?
N) )A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
lR No
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
JR No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
Z No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Rl No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
M No
7/25/97
Continued on back

FacifityNumber: —232
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
0 No
Structures (Lagoons.11oldine Ponds, Flush Pits, etc.l
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:................................................................................................................................................................................
...................................
Freeboard(fty.......................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
®.No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
P9 No
Waste Application
14.
Is there physical evidence of over application''
[]Yes
RjNo
(If in excess of WMP. or runoff entering waters of the State, notify DWQ)
15.
Crop type ....s a..Y...r..................................Scl. e. w :............................. ........W k_........................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
RI No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
Q No
18.
Does the receiving crop need improvement?
❑ Yes
lR No
19.
Is there a lack of available waste application equipment?
❑ Yes
EINo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
R) No
21.
Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑ Yes
14 No
22.
Does record keeping need improvement'?
❑ Yes
1$No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
Jallo
No.violations or deticiencies.were noted during this.visit..You will receive no further.
correspondence about this visit.
YES
Faci I t-y tsI LN't joed
l� o PLO tit Cxct td- a R,t!i : e P la t�v,i` N o J
r r r, 0. r!�'=�. r n �.0 Pp y..,1 {- � � i yl) v p t 4 .y�, o v� b V .M-B t p .1 �. ✓�lt�v� JIw
N�
dp v`4 f� v � o i'� e
7/25/97
Reviewer/Inspector Name j V4
Reviewer/InspectorSignature: 0"kk_A� Date:

•
•
Site Requires Immediate Art nn n: /W
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION; SITE VISITATION RECORD
DATE: 801 , 1995
Farm Name/Owner:
Mailing Address:, F-)
County: l LIPL)
Integrator.
On Site Representative:
Physical Address/Location:
Type of Operation: Swine
Design Capacity: 0
Phone:
Phone: / �s
Poultry _ Cattle
Number of Animals on Site:
DEM Certification Number:
rAACE DEM+C/e tcation Number: ACNEW
Latitude: 3�' 7 �' el " Longitude: 72 ' T 1�3 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches es r No Actual FreeboardJ' ' . � Inches
Was any seepage observed from the lagoon(s)? Yes r No Was any erosion observed? Yes r No
Is adequate land available for spray? Yes or No Is the cover top adequate? Yes or No
Crop(s) being utilized: '� /O-P (�OiQ
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Yes r No
100 Feet from W.ellsYes r 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 iMap Blue Line? Yes or No
Is animal waste discharged into waters o e state by man-made ditch, flushing system, or other
similar man-made devices? Ye or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific a with cover crop? YeNo
Additional Comments:L"k�g
0�14
��)� F�i11'!31 � S/�� fir✓
cc: Facility Assessment Unit Use Attachments if Needed.