310244_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Reason for Vissiit::�s-prik-oru-ttine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
: Date of Visit- yt I fib Arrival Time: ® Departure Time: 3-0 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
V< <h act t,,..r.Js
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: I f & r ( 7
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle CapacityPop.
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
feeder —to Finish
Farrow to Wean
5 9 l9ir7
1)r. P,oultr. r
Layers
Design
Ca grit
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
01
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes ❑] No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: -31 Date of Inspection: z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21 o— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -33
--3-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E57No ❑ 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 ONo ❑ 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
o NA
7. Do any of the structures need maintenance or improvement? ❑Yesg�No
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 2❑ 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 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E NV ❑ 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
oo ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ea o ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ❑'Flo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number; I - Zif L4 Date of Inspection: Z 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes OlNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [2N ❑ NAB ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Q'NA ❑ NE
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
7 No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
g
No ❑ NA ❑ NE
No ❑ NA ❑ NE
]No ❑ NA ❑ NE
Reviewer/Inspector Signature: {� Date: 2 2 /
Page 3 of 3 21412015

for
Referral
Other O Denied Access
Date of Visit: / ]r//Q, Arrival Time: Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
t c-C/"'��
Onsite Representative: N' � hn c s IC C Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Certification Number: / r(0S ( 7
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
eeder to Finish
27 i D
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Design
a acit
I
Current
Fop.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Pou Its
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] 1Vgo ❑ NA ❑ NE
❑ Yes rj�No ❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facilitj Number: 3 jDate of Inspection: /,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ff 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
ffNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ry�
P11� ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
6 No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MNo❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
w
❑'No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑LeaseAgreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0--No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yesa No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number, `( Date of —Inspection, / b
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 EfNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Zj NA ❑ NE
Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 2]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 Q N ❑ 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.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA [i]' EE
❑ Yes ENo
❑ Yes 2�] No
❑ Yes E3<o
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer<ti)question #) Explain any YES answers and/or any additional recommendations or any other comments.
Use .i drawines of facrhtvsto better. eailatn'•`situa'fions(use additional pages as necessary).
Reviewer/Inspector Name: Y G� t `lp l Phone: r� 9 ,72 6 73 9�
Reviewer/Inspector Signature: — �' ll� Date: [ a le- 4'
Page 3 of 3 2/4/20

2Y
(Type of Visit: UCompliance Inspection ()Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint 0 Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: 5//!(/i5 Arrival Time: 9® Departure Time: p 0 -sh-D County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Ali C �0(4 S
Certified Operator:
Back-up Operator:
Title:
C"<rc(S
Location of Farm: Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
P.
Design C•ucrent
Cattle Capacity Pop.
DairyCow
V4ean to Feeder
Non -La er
DairyCalf
Feeder to Finish
P (4pr
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . + P,oult .
Layers
Design
C•a aci
Current
P,o -
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes L. I ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
\ Page I of 21412011 Continued

Facility Number: - 3 1 - - Zy( Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I 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 -]/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 IN U ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNoNo ❑ 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 ff �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E]'R o
❑ 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
]HNo
❑ 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
�Ko
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili •Number: - 741 y Date of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U N
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑NA ❑NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [�j 'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes fNo ❑ 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?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
[:]Yes [ No ❑ NA ❑ NE
❑ Yes aNNo ❑ NA ❑ NE
❑ Yes (J'No ❑ NA ❑ NE
............a..�pw....... a..w. ruvuc. , I v r .
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412014

Type of Visit: RrCompliance Inspection' 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ZRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: I: b County: 01446
Farm Name: A%Xl Gejnwan Q Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: At;L--p ®. ( Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: L�IR n
Phone:
Certification Number: qn 125 ID_
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
ILayer
Design
Capacity
IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I
INon-Layer
IDai
Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
nit,
I) , + P,oult .
Layers
Design
C•_a E
Current
Pao ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
I
Beef Feeder
I Beef Brood Cow
Boars
Other
Other
Turkeys
Turke 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 jo No ❑ NA ❑ NE
❑ Yes ❑ No
[-]Yes [—]No
[:]Yes
[:]No
❑ Yes
75 No
❑ Yes
ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

a
Facility Number: -OLLf jDate of Inspection: ..3
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes allo ❑ 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
;�ONo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
2TNo
❑ 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
[ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Lallo
❑ 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
L21�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ZfNo
❑ 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
rJ( 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 Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑' Yes XNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: -
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
)21No ❑ NA ❑ NE
VNo ❑ NA ❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
V] No
❑ NA
❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑ Yes V] No ❑ NA ❑ NE
❑ Yes F] No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes XNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 1VNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes I/ I No ❑ NA ❑ NE
Comments to question ft Explain any YES answers and/or any additional recommendations or anyothercomments.
Use drawings of facility to better explain situations fuse additional pages as necessarv).
Reviewer/InspectorName: 7,ul-M l/ma
IN J — _d
Reviewer/Inspector Signature:
Page 3 of 3
Phone: &W —b
Date: 3 n-14
21412011

Date of Visit: Arrival Time: Departure Time: +; D County: L/1160( Region:
%�j Farm Name: A'�"&4&' , AAiT Y1 &VVY\ 9 — Owner Email: �V�
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative:
Integrator:
Certified Operator:
vL.t �ti�M
©•
Certification Number:
%• 0i6
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
]Layer
Design
Capacity
Current
Pop.
Design Current
Cattle CiTy Pop.
apac
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
`R
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
l_,
Layers
Design
Ca aci +
Current
Pao
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBecfBroodCow
EMIRM
01 Other
Turke s
TurkeyPoults
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 . No ❑~NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes
[:]No
❑ Yes
4—No
[—]Yes
�lo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

C`y?; Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [—]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): P.
Observed Freeboard (in): s?j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes /n'No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
r
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 4No ❑ 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 2fNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 2No
❑ 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
J
require ❑ Yes I /I No
❑ NA
❑ NE
maintenance or improvement?
III""""""
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 6No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0No
❑ 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 J?rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
J�rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VrNo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VTNo ❑ 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 6No ❑ 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 Vrl�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ;;�[No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili } Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ja No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes VNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes 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 V] 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
0 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
Z 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
Z 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
Q No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
m No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
—Thwt-e(3> 5,-•,aU +rces/Sl�rubj o be r�,�ov�� or buck
L&V s,fie &�-
Reviewer/Inspector Name: �l 4XWN O �.
Reviewer/Inspector Signature:
Page 3 of 3
Phone: oq5;�W_ ;6
Date: M-041
21412011

Evaluation U Technical Assistance
for Visit: _ )�Aoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrrival Time: Departure Time: County: b(nFL4" Region:
Farm Name: �� �Iq(LeA S Owner Email:
Owner Name:
�c)CTE t2 F nWA41Og Phone:
Mailing Address: W(iA_Xt� k�C>CASMOs (5E(&C oull.LF /VC6xjS140
Physical Address:
Facility Contact:
Title:
Onsite Representative: Co L facuD s, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design C>urrent
Capacity Pop:
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
$
D . P,oultr.
Layers
Design
C_a �acity
Current
Pao ,
DairyHeifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
—TurkeyPcults
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: —j ( - �/ Date of Inspection: /(p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'ittttt�No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑��0 No
Structure 1 Structure 2 Structure 3
Identifier: �jJP
Spillway?:
Designed Freeboard (in):
19.5
Observed Freeboard (in):
-Z;� (
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
IA I No
❑ NA
❑ NE
waste management or closure plan?
i'�
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
y�
I )t I No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0�No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable zCrop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
`1
12. Crop Type(s): S C
13. Soil Type(s): V" C,)
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
[A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
KNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�[
I Jll No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V�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.
❑ WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ''0 Yes No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑i Waste Analysis Q Soil Analysis ❑ 1praste Trans ers ❑ Weather Code
Q Rainfall ❑ Stocking ❑ C op Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes V 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 21412011 Continued

[Facility Number: - Date of Inspection: J (p I
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 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?
34. Does the facility require a follow-up visit by the same agency?
IK I No ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Yes �g No
❑ Yes 1A No
❑ Yes No
❑ Yes 71V I� No
❑ Yes No
❑ Yes 1ANo
❑ Yes 4 No
❑ Yes OQ No
❑ Yes `$LNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any othercomments. -
Use drawings of facility to better explain situations (use additional pages as necessary).,
alo• NO �C�I e>IGu����; WdUu� pt -Co w ct S —Ctp
Q1fYls
,a l c ALrI
wA
1-7
u6�7�o14
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �nn�G�o�3d,
Date: aLl wa
21412011

(Type of Visit 19 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit ys Routine' 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: cArrival Time: ft� t Departure Time: County: IN Region:
Farm Name: ��"� r 10o� VZ m� Owner Email:
Owner Name: 1�EX 1 ��I r— D�1�t2U�^S n 1 Phone: 4 aA;l7re —S a(o8 W
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representativ : xT�CZ- �1JwAR-DS Integrator:
Certified Operator: CTGR- EDwA4Z D Operator Certification Number: -'�✓ ""�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o='=" Longitude:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes XNo ❑ 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
❑ Yes
0
❑ No
❑ NA
❑ NE
❑ Yes to
o ❑ NA ❑ NE
Yes ❑ NA ❑ NE
Page i of 12128104 Continued

Facility Number: 1 —,9W I Date of Inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes )�No ❑ NA El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes D No ❑ NA ❑ NE
l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
/ ,,Structure
Identifier: LA600,9I
Spillway?:
f
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes '*$No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
.,,(,
El Yes lil No ❑ NA ❑ NE
through a waste management or closure plan?
J
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes '$ io ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes '[A Qo ❑ 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/improvement?
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 > l0% 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 'P�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
r- No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
to
El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
I Comments (refer to question #): , Explain any YES answers and/or any rec, mmeodattons or any other comm nts' 'I
Use drawings of facility to better explain situations. (use additional pages as necessary) x
...ar w
Reviewer/Inspector Name 61 / Phone: 'l/D- )r1& - Ou -7
Reviewer/Inspector Signature: Date: ry 11 3
Page 2 of 3

Faciflty'Number: Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
U.No
❑ NA
❑ NE
the appropriate box. El WUP ❑ Checklists El Design El Maps ❑Other
\.y�
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
/
El Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ )/nual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections 0 Monthly and l"
Rain Inspections 0
Weather Code
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
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,�.,(No
IdJ No
�
lRN
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
VVV��```"""'''
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
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONO
❑ NA
❑ NE
Additional Comments and/or Drawings:
� ��► ��ID I .S
Au1¢47ICN
Page 3 of 3 12128104

Type of Visit Co�mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 6Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: �� County: t%✓ Region:
Farm Name: Alm S Owner Email:
Owner Name: X � C-� ` DuYai RDS Phone: 1i0- "5& 3_4tDR Cwl
Mailing Address:3o['_� LA-_)ILL,*ab �DwAQOg 1LD It,LAU1Cc.E.NG daJ��
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: I'LiEXTEL Cow�L�1JS
Back-up Operator:
Location of Farm:
Phone No:
Integrator: T
Operator CCeertifi Certification Number: /(O'S(OL/
Back-up Certification Number:
Latitude: = 0 Q , = Longitude: 0 0 M ' F-1 "
Swine
Design :' Current 3 Deslgn Current
Capacity 'Population , : Wet Popltry C,apactty Populahon
{ � + D ign
Cattle l � Ca act
Current
Po man on
)LL
❑ Wean to Finish
❑ Wean to Feeder
I 4'
❑ La er
❑ Non -Layer
❑ Dairy Cow
' ❑ Dairy Calf
"
Feeder to Finish
"'" °' ,P,>,�, ^'r"r;�.+'
- DPopltry ry ,,
'`
ns
❑ Dairy Heifer
Farrow to Wean
El Farrow to Feeder
El D Cow
El Non -Dairy
-
�� ❑ La ers
❑ Farrow to Finish
❑Gilts
❑ Beef Stocker
`. ❑Non -La ers
ElPullets
❑Turke s
❑ Beef Feeder
❑ Boars
--
Other,
❑Beef Brood Co
�
' Numb 11. Stru o Sctures:
- ' ...<:.'-�"`
❑ Turke Poults1,01.1
❑ Other
❑ Other
. • .+..asp;,...,.. .. . �.. ._•., »,e-...;r.
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 y'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
12�No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
12128104 Continued

Facility Number: 1 —_I�/ 11
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ( AGiW/U
Spillway?:
Designed Freeboard (in): l //]
. s
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes V No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ` kNo
❑ 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
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
�{,�[
El Yes /MJ\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 ,Q,,1 No
❑ NA ❑ NE
maintenance/improvement?
1
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) & e-(j�) S C 6'�
13. Soil type(s)
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 9LNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes 1;5-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes *o
[:1NA
[:1NE
18. Is there a lack of properly operating waste application equipment?
�
❑ Yes l+lo
❑ NA
❑ NE
IComments (refer to question #): Explam;any YES answgrs and/or any recommendation or any otherr cowmen
Use drawings of facility to better explain situations. (use addthonal pages as,necessaq)
Reviewer/Inspector Name I Q g C� iN 5 Phone: 5/0J 130�
Reviewer/Inspector Signature: Date: --5 1 KVJ(/ )
12128104 Continued

y Facility Number: — (/y Date of Inspection O
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes $No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes -;AN. ❑ NA ❑ NE
the appropriate box. El WL1P 0 Checklists El Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. �/` El Yes O.No [I NA ❑ NE
❑ Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis Elyaaste Transfers El �ual Certification
El Rainfall ❑ Stocking [I G Op Yield E] 120 Minute Inspections 3 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 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
3 L 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?
Addrhonal;CoWmmen[s uNor�Dra�ngs:
w Q.
y
C�-Ic3a.A��dv puE bolo
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
FINo
❑ NA
❑ NE
El Yes
No
[I NA
[I NE
❑ Yes
7�,No
❑ NA
❑ NE
❑ Yes
PfNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
5�No
❑ NA
❑ NE
❑ Yes
$4 No
❑ NA
❑ NE
❑ Yes
$�iDIo
❑ NA
❑ NE
12128104

Type of Visit (Cotompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit:( Arrival Time: ® Departure Time: County:
Farm Name: w� r �Al2�-(^Yi Owner Email:
Owner Name: I,EXT�t2 1=�W{��S Phone: 9%6-
VIt =
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: t�exT E2 TAW Aw.S
Certified Operator: h�1 gL_ 3
Back-up Operator:
Location of Farm:
Phone No:
Region:
Integrator: I_
Operator Certification Number:
Back-up Certification Number:
Latitude: nO n n Longitude: non n
Swine
Design Current Design Current
Capacity Population Wet Poultry Capyaci Population
Design
C+attle Capacity
C•ucrent
Population
❑ Wean to Finish
La er
❑ Dai Cow
❑ Wean to Feeder
Non -Layer
❑ Dai Calf
91 Feeder to Finish
iS8O
U
❑ Dai Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Dry Poultry
La ers
Non -La Non -Layers
I
❑ D Cow
❑ Non -Dairy
❑Beef Stocker
❑ Beef Feeder
Pull
❑ Boars
❑ Beef Brood Co
Turkeys
Other
❑ Other
15511
Number of Structures:
❑Turke Poults
❑Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes NNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number.S I - yy 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: _ L/X achy
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
p(1 No
'kNo
El NA
❑ NE
El Yes
❑ 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 ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O\No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ' \
❑ PAN ❑ PAN > 10% or 10 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
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
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name I lA1 S Phone: -7l0-17(O- ?` —
Reviewer/Inspector Signature: Date: Signature: Date: Q /J 3 )0c3 ��c-
Page 2 of 3 12128104 Continued

Facility Number: 3 / o%L/ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �j 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other tX
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IoNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Q Waste Analysis ❑ Soil Analysis ❑ baste Transfers ❑ A nual Certification
❑ Rainfall ❑ Stocking El op Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections Q Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 10 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
'Addifional'Comments and/or Drawings- . .
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
§jNo
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
oNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number 3 o�y t ( O Division of Soil and Water Conservation
_. _ - O Other Agency
Type of Visit 13 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine Q Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: 7F O Arrival Time: 9 cp Departure Time: County:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: QQ Title:
Onsite Representative: H GtnS 1 OT/
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = c = ' = Longitude: = c = , = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
10 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Stmcture ❑ 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?
❑ Yes IM No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
MNo
[]NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
12128104 Continued

FacilityNumDate of Inspection I 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LIR No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L 4600 W
Spillway?:
Designed Freeboard (in): nn C
Observed Freeboard (in): C J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C�j No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental 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 m No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes jo No
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 19 No
❑ 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)
[I NA ❑NE
❑ NA ❑ NE
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ej 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
fO 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):
,Q(O. C ET copLL�,oE a1G o1 KEEQ W/
StcK w�-P
sEyvv� copv!� 10
Reviewer/InspectorName Arhonm�<cc..A.�ty63Z Sat4yy rAt<NEL(, i Thone:
Reviewer/Inspector Signature: rl • Owr�y Date: o9 II

Facility Number: 3 -aN Date of tnspecfion >� /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes � No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes IN No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes AVE No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a min gauge? ❑ Yes fffNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes C 'No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M NO
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
> No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
-H Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
krNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
��yy
tONo
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
d 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
q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
lKf 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
q No
[INA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

J" Division of Water Quality
Facility Number �.,— 0 Division of Soil and Water Conservation
---- — 0Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 19 Arrival Time: Departure Time: / C only:
Farm Name: '0/0
/0 �Owner Email:
Owner Name: Phone: _
Malting Address:
Physical Address:
Facility Contact: n 'G Title:
Onsite Representative:
Certified Operator: G.i�.:✓ /i/JU� i05
Back-up Operator:
Region: AVIW9
,//�� Phone No:
Integrator: /� 'e'ohw�(%lt'Dd�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: Q o = ' =" Longitude: = o =, = "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La et I
_
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes {U No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes iQ 1 ❑ NA El
ElYes XNo ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of InspectionI
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
���...,,,,,,(((
El Yes y No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes /❑ No ❑ NA ❑ NE
. Structufe 1 Structure 2 Structure 3 Structure 4
Identifier: 7_
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
r
El Yes yJ No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
16
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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ILJ 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 X
10.Are there any required buffers, setbacks, or compliance alternatives that need ElYes No ElNA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes No
17. Does the facility lack adequate acreage for land application? El Yes Id No
18. Is there a lack of properly operating waste application equipment?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes "[7No ❑ NA ❑ NE
IComments (refer to question ft 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):
2�/6�oi-y ozL
36 -'9' h,
IReviewer/Inspector Name _ ��/� ��� Phone: G%%DI rip 13Z 91 I
Reviewer/Inspector Signature: Q�1 7 �i`/ Date: 5 3 0 9t
Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JA No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other ,_,(
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes lL1 No El NA El NE
El Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers/ ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
A No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VfNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
01 No ❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1 No ❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[I NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,VNo
I[J No [I NA El NE
Other Issues
/,,,___,,,(((
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IJJ 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?
El Yes
���fff
lJJ No El NA ❑ NE
If yes, contact a regional Air Quality representative immediately
/
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No ElNA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/O��,,,///
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ld No ElNA ❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
/ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
A)b
l212VO4

f0 Division of Water Quality
Facility Number j O Division of Soil and Water Conservation
-- — -- O Other Agency
Type of Visit 9rcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �Departure Time: County:
Farm Name: P 64Rm Owner Email:
Owner Name: 1.- QWARD5 Phone: _
Mailing Address:
Physical Address:
Facility Contact: /� Title:
Onsite Representative: 0"m7 zf �✓i td4e4a
Certified Operator: e&r Tiz/1
Back-up Operator:
Location of Farm:
Swine
-. ❑Wean to Finish
❑ Wean to Feeder
I[YFeeder to Finish
❑ Farrow to Wean
Other
❑ Other
Region: 4/. A70
//�� Phone No:
Integrator: / 44g0fir/— t[ Q
pDcksn%
Operator Certification Number:
Back-up Certification Number:
Latitude: a o = I = " Longitude:
Design Current ; .Design Current. - I7
Capacity Population WetPoultry Capacity Population Cattle Ca
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?
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)?
Mew
Number of Structures: , FT
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
❑ Ye1XMNo
No
El NA
❑ NE
❑ Ye
❑ NA
❑ NE
12128104
Continued

Facility Number: — q-4 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?
Struchye I Structure 2 Structure 3 Structure 4
Identifier: OP
Spillway?: A_
Designed Freeboard (in):
Observed Freeboard (in): L-j/
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?
❑ YesZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Z&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 PrNo ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I[,J 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 �❑ AApppliic�attion Outside of Area
12. Crop type(s) !S/%V��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes rrr No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes y� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 16 No El NA ❑ NE
17. Does the facility lack adequate acreage for land application? El Yes / y— No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [Z'No ❑ 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):
F,t.,) Koo,ejl9 �,64,RRDc✓6 /VO7ze4o A
2 r� e41V L/sx- !. '� �9,r�,� /, aoo� 7�s>F90 ©F / S Foe 444a115f.
�FPf�'inB�4 /�No �i�ec � �c>o8E2 Gl/�-s�F /��'�zc.¢rco.�s 'stE lrJHs>E
f�,✓.9 d5ys loce5?;6ez —/Uzck 4645 6o4_1, ,,_oAa Ve i�de Fti
I Reviewer/Inspector Name 1 T� (lJ� 1 Phone: p— /p- � �-
W 64f- I
Reviewer/Inspector Signature: Date:

Facility Number: J/ —,9 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 14 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA [INE
the appropriate box. ElWUP ElChecklists ❑ Design ElMaps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes T No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
/No
❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P�No
❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VfNo
❑ NA [I 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
J ] No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Q] No
[INA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L No
❑ NA ❑ NE
Page 3 of 3 12128104

IType of Visit A Compliance Inspection O Operation Review — O Structure Evaluation O Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: /0 29, Arrival Time: Departure Time: I %; %/JnnA�-ounty: Region:
Farm Name: `AQ/Y) "`���"`��""YYYO44wnerEmail:
Owner Name: lrr/GfIL (G,24!l&19 S Phone:
Mailing Address: _
Physical Address: _
Facility Contact: Title:
Onsite Representative: t �,�Lf��6�,Q_s
/�
Phone No:
Integrator: G'1121&c�
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o =.
= Longitude: = o =' = "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
12128104 Continued

Facility Number: —G Date of Inspection /O
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: /P
Spillway?: 11119
Designed Freeboard (in): 1
Observed Freeboard (in): _9-
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 g No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes /F-' 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 A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JdNo ❑ 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ONo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) (/`� �,ffnl!/�i9 i/�<i7Fii ��i11?s✓�/���F��
13. Soil type(s) 0614
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 VNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes 9No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes f,0 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Z No ❑ NA ❑ NE
/5 j�virl� Gt'/f5D LoaT�foG iv�,oFd,L,� ��B /"�_
X T 2/ �� �Gr/zu �✓<co T�� e4<:!5� Ste, r
Reviewer/InspectorName Phone:'?W-,��=3QODy2=
Reviewer/Inspector Signature:
Date: Q20/22 S
12,28/04 Continued

Facility Number: J/—G Date of Inspection I �/
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes yJ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other ,...,(
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes f!J No [I NA ❑ NE
[I Waste Application ❑ Weekly Freeboard El Waste Analysis El Soil Analysis El 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 )ZfNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes A No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes JXNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes 11
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
,,L___/,,,J(((No
ElJ[I Yes No
❑ NA
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 2rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes Y/J No
ElNA
El NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes �No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
.
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes )� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes PNo
❑ NA
❑ NE
Adwtional Comments and/or Drawin
/1/�l'r �..ca-cos ilJ - /��o
`%'ads l Af- 7�- G-�,o &O'v-
12128104

of Visit j0 Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit p Routine O Complaint O Follow up O Emergency Notffication O Other ❑ Denied Access
Facility Number Date of Visit: 4 Time:
Q Not Operational Q Below Threshold
$Permitted VCerti6ed 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ...... _........ Of... ................ .... _........ _._... _...... .. County: .... OUR _.
Owner Name:
Mailing Address:
Phone No:
Facility Contact: ...................................... ......... ........ _. Title: .._....__................... ........... Phone No: _............. ...........
Onsite Representative: ...Q � [?lnl�t Integrator....Chm. . u
Certified Operator: ._.... ............ ._............._........... .... Operator Certification Number:
Location of Farm:
❑ Swine ❑ poultry []Cattle []Horse Latitude =• =' =" Longitude =• =, 0..
Discharges & Stream Impacts �
1. Is any discharge observed from any part of the operation? ❑ Yes of 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)
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
❑ Yes
2. Is there 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
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......... I._........... _....................... ___... _............ .... _......... ....... ........................ ...................
Freeboard (inches): �-
12112103
❑ Yes
Structure 6
❑ No
6d'No
:No
N0
Continued

Facility Number: ' — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie//trees, severe erosion, ❑ yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes OeNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes L� �O
9. Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level ❑Yes [�N0
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type AER MVDA ( 6 ) SCV O
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ___ 0 /
14. a) Does the facility lack adequate acreage for land application? ❑ Yes QNq�
b) Does the facility need amettable acre determination? ❑ Yes [�N9//
c) This facility is pended for a wettable acre determination? ❑ Yes �2NNo
15. Does the receiving crop need improvement? ❑ Yes o
16. Is there a lack of adequate waste application equipment? ❑ Yes [a1 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 ET -No
liquid level of lagoon or storage pond with no agitation? ,u,//
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Field Copy ❑ Final Notes
OwOA- NAD AM#[&$191Y1fffT p uSE PMLAY cr) #J6161460a F.W-0) t,FW A6A5CM
WAY POA'&- j r Cov-MAJ06j (/SE BE Su,eE Ta Acewa tk tJ6e j LC-_AsE ,
SWD66 Sd/w& MV Cf►U99A-r-ZaJ &AJ6. OIS7a J Jtn AX59 PUq(C *N
�ELo>z05 SN Gcb� ORDER, FAJ M OyCk Ail. ,:0) G&vD <Linp( ,
Reviewer/InspectorName
Reviewer/Inspector Signature6r� _ 111�IM1 can Date y 5rON
II/71M

Facility Number: 31 — 2.qql Date of Inspection 14l ? /dF9 I
Required
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
—f/
21rv0
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
3
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
25.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
Did
❑ Yes
0 No
the facility fail to have a actively certified operator in charge?
❑ Yes
;'No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
NNoo
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[�]"N!o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
kNc
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ Stocking Form ❑ Crop Yield Form []Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit .0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit RfRoutine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit:
Facility Number
Permitted 0 Ce((rtti�ifi(e'dd 0 Conditionally Certified 13 Registered
Farm Name: ll F' yilgm
Owner Name: ex-Trt2 FDLx)Kpp
Mailing Address:
Time:
Date Last OperaAor Above Threshold: _
County: tAVLzIJ
Phone No:
Facility Contact: Title: Phone No:
OnsiteRepresentative: 1'F_ CowKRn p5 Integrator: ) WDLL
Certified Operator:
Location of Farm:
Operator Certification Number:
;6 Swine []Poultry ❑ Cattle ❑ Horse Latitude 0' =, =" Longitude =' = =
'De
cs�
Farrow to
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VfNo
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 INo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Pr
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Z No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): G G
05103101 Continued

Facility Number: S1 — Z Date of Inspection
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 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,,,.....9,,,{{{ No
11. Is there evidence of over application? r ❑ Excessive Ponding ❑ PAN[]
Hydraulic Pverload � ❑ Yes t�1 No
12. Crop typeERI'rUOA�IGRPc2el Sm0.u_ (�-12RZ,J 1f)vERSC—Epi /
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management han (CAWMP)?
i
El Yes
R1 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
O No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
T No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O No
Required Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
V(No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
�t,
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
2I No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�ZrNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Y No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
&No
(ie/ discharge, freeboard problems, over application)
❑ Yes
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VNo
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 AAW?
❑ Yes
V No
JU No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit�No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
,. _ e _. _
Comments (refer to gu ffion #): `,Ezplain anyYES answets aadJtii•-say recommeudatiops oraoy otheccom_ments.:: ;.. -. -
Use drawings of facility _to better.eiplam sitnatiopsr(useaddrnonalipages as necessary) Field Conv �1—I Final Nines
i9�
�1J,`Ea �
ZDD2
Soya � T ��PaQr,
Reviewer/Inspector Name
Date:
05103101 — '
Continued

Facility Number: — Date of inspection
Odor Issues
2& Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 0 No
El9 Yes No
❑ Yes [p No
❑ Yes (p No
❑ Yes No
❑ Yes ❑ No
1`Additional Commentsand/or Drawings: - _-
N���; Fz4r .�
O5103101

Division of Water Quality -
Q Division of Soil and Water Conservation
y`. Q Other Agency .
Type of Visit 'K Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for VisitjF Routine ()complaint O Follow up O Emergency Notification O Other 0 Denied Access
Facility Number Date or Visit: Time:I I MJ Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Permitted E3 (Ceer�ttiifierydd Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
FarmName: .......D..1.......1..................................................................................... County: .... �1!`{!A1.111 .........................................................
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
:Mailing Address: ..................................................................................................................... ..
..................................................... ..........................
Onsite Representative: ........ Integrator. ....C��..A:.,yaa.)...................................................
Certified Operator:
Location of Farm:
Operator Certification Number: ..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =.. Longitude = • =' ="
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Po ulation Cattle Capacity Population
❑ ❑ Wean to Feeder Layer ❑ Dairy
Feeder to Finish eD --j IrQ ❑ Non -Layer I I I[] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other _
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
No Liquid Waste
Discharges & Stream Imoackc
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 pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............................................................................................................................................................................
Freeboard (inches): 30
5100
❑ Yes XNo
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes O<No
❑ Yes [�No
❑ Yes WNo
Structure 6
Continued on back

' Facility Number: 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
XNo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
ONO
(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
ONO
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
XYes
elevation markings?
❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
lk No
11.
Is there evidence of over ❑ Exce`ssivetP`onding ❑ PAN ❑ Hydraulic Overload
❑ Yes
9 No
12.
application?
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
kNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
KNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
2jNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
kjNo
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?
W' NtJ-*i61htidfis:oT 8ef ciendia$ were poled dufttiii thisMsit: - Y:oit will teeeiye iio further
. , corresnotideitce: abouf this visit:
❑ Yes D(No
❑ Yes XNo
❑ Yes tj�No
❑ Yes KNo
❑Yes WNo
❑ Yes yNo
[]Yes VNo
❑ Yes WNo
Comments (refer to question #): Explain any YES answers and/or _any recommendations or any other comments. = a
Use drawings of facility to better explain situations. (use additional pages as necessary): ' - ` d
VD��c�(�e(, see cam►.-.�esj� 3�r2�(
1 I I
l J 2Q Cat � �wRy Abdl.�� SLy�t tY� -� mil ✓ �l g`� ` � \O 60ek qw'
Reviewer/Inspector Name
Reviewer/Inspector Signature:
24
Date: ( 5R10

"wan
Facility Number: J\ —g(f4 Date of Inspection Printed on: 10/26/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
VNo
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
f 4No
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
6po
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
ONO
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
5100

Facility Number 3 I 2L} I I Date of Inspection 1 WZG /pp
Time of Inspection 2 S 24 hr. (hh:mm)
® Permitted [3 Certified 0 Conditionally Certified 0 Registered Not O rational Date Last Operated: ..............
FarmName:.....Fil.�.'..'.:'.::..................................................................................... county:.'Dup 1.!_n............................................
rJ
Owner Name:....... JC... e'.r..................L.:..I.t^/Q .. .0 ................................................
PhoneNo:...........................................................................
Facility Contact:
Title:
Phone No:
MailingAddress: ..................................................................................................................... . .................................................................................... ..........................
Onsite Representative:..' 1..�'.-..i�..L.'. r.4... V/q✓`I.......................................... Integrator:..4.i �!.�'/'O. �.....r...................................................
Certified Operator:
Location of Farm:
Operator Certification
Latitude =•=' =" Longitude =a =' ="
`. .. .. .°.., Design-
`_ Current; ' . - '.
- Design :;Current .:Design Current'',.:.
;$wine':' "'Ca acit
`,'Po'ul3tion' Poultry.
Capact Po`ulation..„„Cattle - '
ty:� ,'F, , Capaei �Po ulation':.
-
-'. ❑ Layer
..- ❑Dairy ,_
';. ❑ Non -Layer'.
❑ Non -Dairy:.
❑ Other
Total Dest n Capacityz
Total SSI:W.
- ='Number.of Lag" `'�
Subsurface Drains Present ❑ Lagoon Area Spray Field Area
Holding Ponds / Sohd Traps=� ❑ No Liquid Waste Management System ;
❑ Wean to Feeder
® Feeder [o Finish
❑ Farrow to Wean
❑ Farrow [o Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes 'S 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? h/Gt
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes J( No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes JHNo
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: I
Freeboard (inches): .......... _Z S
..................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
3/23/99 Continued on back

Faoility Number: 3) —Z Date of Inspection
` 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
L-L,L-C�LIJ
❑ Yes
Cd No
❑ Yes
[01(No
❑ Yes
ONo
❑ Yes
V6 No
❑ Yes
0 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ;6No
12. Crop type !) e.Y' »'t V 0l A ,nc�.�C, r SiKA I ) 6'r..t i r1
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?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
V';Vq violafititis;oi deficiencies •were itotet7• during this;visit; You will i eeeiye rio; fui ther
correspondence. A6o f this .vtslt_ .1. .
Comments -(refer -to -question #): Explain. any YES answers and/or any recommeudatioas or any other comme
as necessary);.
❑ Yes ❑ No
19 Yes ❑ No
❑ Yes %No
❑ Yes Of No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes ( No
❑ Yes 12fNo
❑ Yes No
❑ Yes No
❑ Yes WNo
IS. h/or< 4o
el bveeols Fr.�, F;e1d `
�- ( ork �o el;n;n7ale
non 6er-r,,vdg 9rasSel m fie IA-f Z-b 3 lI✓74 ze4er' eS4016/ifh
bc.r,•,,v�(y ih->lhese �';elAs. 3rrle Gv� w1a-]��rial r,s sQOL, �I.s
Poss; 6(e.
Reviewer/Inspector Name I,;*
,e
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: ,3I - 2 v Date of Inspection 2 D'
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ONO
❑ Yes 29 No
❑ Yes [I No
❑ Yes W No
❑ Yes ZI No
❑ Yes B No
A Yes ❑ No
Additional, . `onnnents°e ON lFi!!ingS -Z._

Facility Number Date of Visit 2/18no00 Printed on: 3232000
31 244
Not Operational O Below Threshold
Permitted NICerfified D Conditionally Certified 13Registered Date Last Operated or Above Threshold: .........................
FarmName: DP.Earm.......................................................................................................... County: D.uplio................................................ MRO.........
OwnerName: Drater..................................... Edvtard&.............................. _..................... Phone No: J48.3Q12....................................................................
FacilityContact: .............................................................................. Title: ................................................. _............. Phone No:...................................................
Mailing Address: 32j,.Willard.E.dwArda.Raad........................................................... BPUJAyft..NC ...................................................... 285.1R.............
Onsite Representative: ........................................................................................................... Integrator. Carrall.'&For daluc.............................................
Certified Operator. lleater..................................... Edward& .......................................... Operator Certification Number- ..1b3f9.............................
Location of Farm:
® Swine ❑ Poultry ❑ Cattle Latitude ®• 55 < 36 � Longitude 77 • 41 06
Discharrees & 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...................................................................................................................................................................................................................
Freeboard(inches): ...............20..................................................................................................................................................................................................

Facility Number. 31-244 Date of Inspection 2/18/2000 1 Printed on: 3232000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
r seepage, etc.)
1.
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (id 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?
-l�io'v'inlatiirua or:deftciericies•were:rioted:during ttiis'visit:: Yoti ivl7Creceive:uu fiirtlier:' :'
..........................................................
.'.FnrracitrioNBrirw 9M�it'tRic. Lici►.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.
Freeboard Check. Farm Manager (Rudy Kennedy) gave me permission to go on site.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes []No
❑ Yes []No
❑ Yes []No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Name

Facility Number
['' Date of Visit vlarz000 Printed on: 3232000
t 31 244
1 O Not Operational O Below Threshold
® Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
FarmName: DRIarm............................................................................_............................ County: D.upiia............................................... ..iRO.........
OwnerName: BiWar..................................... Edwardn..................................................... Phone No: 29.U.0.1.2....................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: 323..WjUard.Edxrarda.B.pad........................................................... BgLulayjk..NC ...................................................... 28518 .............
Onsite Representative: ........................................................................................................... Integrator: CarrWit.Eaada.Inc.............................................
Certified Operator: Beater ..................................... Edward& .......................................... Operator Certification Number: .106.4.............................
Location of Farm:
® Swine ❑ Poultry ❑ ®
Cattle Latitude • 55 1 F36 • LongitudeF 77 •F 41 1, F06
NumbergfTaggoo& 1 �® Subsurface Drama Present HLI Lagoon Area IN Spray Field Area
#ioMurg=lpasds f$6YdTtaps ❑ gz
No Liquid Waste Management System
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
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 ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:............................................................................................................................................. ......................................................................
Freeboard(inches): ...............20...................................................................................................................................................................................................

Facility Number. 31-244 Date of Inspection 2/18/2000 Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (let trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4fi was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
3/23/2000
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet 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?
;A'No'iiolatiirtiiur.deitiiiiucies'iviie.uoted.duiingtiiiivisit:.Ytitii W'receivenofiirtliei
..........................................................
.'�nnraciirioitArien .'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.
Check. Farm Manager (Rudy Kennedy) gave me permission to go on
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes []No
❑ Yes []No
❑ Yes []No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Reviewer/Inspector Name tsraerlklcr'iekcr

-Q Division of Sod and-.ater Conservation Operation Review
-41
0 Division of Sod and Water Conservation Comphance Inspection
® Division of WaterQiiahty =Comphance Inspection
Other Agency -Operation ReviewT
RRoutine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
Facility Number 31 Zyµ Date of inspection
Time of Inspection 24 hr. (hh:mm)
Permitted [3 Certified E3 Conditionally Certified 0 Registered 0 Not O erational Date Last Operated: ..........................
FarmName:...........��...5.............................................................................................. County: ....�1�1.C`......................................... .......................
OwnerName: .................... I(%..................._�gt'Q......................................... Phone No: ..L'11Q�2_18."301L..................................................
FacilityContact: .............................................................................. Tiitl��e:................................................................ Phone No:...................................................
MailingAddress: ..._3ll........ O.A.6'u)....... EJ...........Q............................ ........... NL................................ ........
Onsite Representative: ............R ltttr.................................................. Integrator: ....._-rY'o.1 S
......r.........................................................................
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude =•=' =• Longitude =• =' ="
Design Current-,
-Swine : :Capacity Population
- ❑ Wean to Feeder
Feeder to Finish 2 6 ZWO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
rl Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current : - l
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:
Freeboard (inches): ............ 3Z......................................................................................................................... ..
.........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes '® No
❑ Yes
® No
❑ Yes
10 No
tJj IN
❑ Yes
® No
❑ Yes
jg No
❑ Yes
P0 No
Structure 6
❑ Yes PNo
Continued on back
3/23/99

Facility Number: 3i — � Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 0 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? M Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [3 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? - ❑ Yes ® No
Waste ADDlieatlOn
10.
11.
12.
Are there any buffers that need maintenance/improvement?
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
Crop type he9-MW)&_ $�d 7.9, sash a ntn
❑ Yes
❑ Yes
® No
® No
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
(V7 No
b) Does the facility need a wettable acre determination?
❑ Yes
% No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15.
Does the receiving crop need improvement?
Yes
® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ki No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
h Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
is Yes
*No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
®No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[0 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[PNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
25.
Were any additional'problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
0' Io viblatiotis:oi deficiencies •wer8 itofed during this:visit',Y:ou :wi11•receiye irio further -:.
coriesporideitce about this visit::
Comments (refer to question#): Explain any -YES answers and/or any recommendations or any other comments. -
Use drawings.of facility_to better explain situations. (use additional pages as necessary)_
7• lnrun-+ wit- dIYk o-Jls of -51vQ 13 it otaeJ- l+W%r or d\)�t wall of 10rri.
be "O. AWA. 11 �,,f, 1_ J 1 /
15. I,� f� VO IUn O,yc seC s ingt�lp/ Y7 f. C oi\TI"o1W •s h # 3,
ii. &(am CcA mm _ eF Coow.)e_ stiWIJ 6*_ VLff w;44, r.,, rtct-ds
Reviewer/Inspector Nameri
Reviewer/Inspector Signature:, Date:
3/23/99

' Facility Number: 31— 2 Date of Inspection
Odor Issues -
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor below
❑ Yes
[PNo
. 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)
I
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
® No
l_
30.
Were any major maintenance problems with the ventilation fans) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
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 ❑ Other Agency
Division of Water Quality
Date of Inspection
Facility Number 3 l Z Time of Inspection 8'sD 24 hr. (hh:mm)
C] Registered IpCertified E3 Applied for Permit [3 Permitted JE3 Not Operational I Date Last Operated:
FarmName: .............i4.�.......) r...................................................................................... County:........htthic...................................... .......................
OwnerName: ................... D.g.)Ar ............... ...... GA'Arl.............................................. Phone No: ... �.91u.�. =. L�.._;W.1.L............................................
Facility Contact:
Title:
Phone No:
MailingAddress:..._ 23.......
..........................................A24t
.I.I4...i...t
S..............................................Z1.501.......
OnsiteRepresentative: ..........�uX�
........
EptAS................................................
Integrator: ......C1
YrF.I.I..............................................................
Certified Operator................................................................................................................. Operator Certification Number;.........................................
Location of Farm:
Latitude =•=, =" Longitude =a 01 ="
" `Design="�Currenf `Design w Current , _ ,Design Current»
Swme Capacity` Population_! Poultry' Capacity Population Cattle � Capacity. Population
❑ Wean to Feeder' ❑ Layer I ❑ Dairy
Feeder to Finish ILNon-Layer ❑Non -Dairy
❑ Farrow to Wean -
�� ❑ Farrow to Feeder = ❑ Other "' a s •�"
❑Farrow to Finish Total Design Capacity
❑ Gilts
[I Boars TTotal SSLW
Number of Lagoons tHoldmg Pond ® s . Subsurface Drains Present ❑ Lagoon Area Spray Feld Area '
a t
„ .._
= ❑ No Liquid Waste Management System t
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
] No
2. Is any discharge observed from any part of the operation?
❑ Yes
[j] 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 gaVmin?
h17A;
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
� No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
UNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
Yes
[IU/.t
N
t.o
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
P No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
r No
7/25/97

- Facility Number:
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
M No
Structures (Lapoons,11olding Ponds. Flush Pits etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
N No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:...................................................................................................................................................................................................................
Freeboard(ft):...............7....................................................................................................................................................................................................
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
QC] No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15.
Crop.type ...............1K.I1.Yt.............................Sri.'41...�Y.X4.......................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
PNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
10 No
18.
Does the receiving crop need improvement?
❑ Yes
J] No
19.
Is there a lack of available waste application equipment?
❑ Yes
[9 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
QlNo
21.
Did. Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
P3 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?
`T Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
rn
1P Yes
❑ No
p•No.violitiousoi
deficiencies -were noted during this:visit.:You:will receive no further:
ctirrespotidence abonf this:visit::.:::: : :: �: • :::: : : : . ::: . : : :: : : :
It.Flod. `t� ;. fit, (o.,ay.9-,,uY be_ rc(ia`4 + e-)04JJ. CatfiU c(ja 0ac sbe_ npveO OR dd'
d:(4. wk\\ 1—a oon o.1a.1� o.a`SaCwX �o ItoJkt S.6JY/f,6e- 'b y ^`
S(ot�- LJu-Ct+� �i•'Ow. ev.�tY1t�` aon.(( ((�� (( l J 11
LL. Lov✓W� t�tSIJ V• SI'�V1P lO�ilA.l] An. 4� C-Cco'/S. AQ�l�ct0.�tcn �W�S t1 Yi.ca
s'V'OA wcft%c CY^ 0�kL � WO. Ptt Iltkk,OK d�kt � St.,,A11 jVk%& OS6') d I& 'x J ap
4L, UUP. QitN becnwUO- Sro2:� a-1 ?-5� (bi/4L. t�'l S vtvN.�r S�ev� Le I�trFT(r).
'"`t'/as. Ma•,or ovetrr..pp�=ca(iow o�- n:(vo5e.-- e.- Sr,N,�l 9�re�„r I G rsltv5�lc.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: - �, Date:

❑ DSWC Animal Feedlot Operation Review , - It .
[� DWQ Animal Feedlot Operation Site Inspection
Facility Number �yg Date of Inspection
(
! 3) L E
i I Time of Inspection ELn24 hr.
0 Registered 01 Certified E3 Applied for Permit E3 Permitted JE3 Not Operational j Date Last Operated:
Farm Name: ,._... yl.l County:.........
.ntn.-.t..............................................................................................\�lkn..........................................................
Owner Name:.......O.GX.�Sr.t.....s;.OGo.12�Y�.ds�...................................................................... Phone No:..._�I1d.}.. Z.Ix.,.SP.Z.........................................
Facility Contact:....._N'.'Chr.....tit wis........................... Title: ........... .d..W.t,.0
Phone No:
Mailing Address: .... 11:3..... W.J.I..... fl.l+.acCr.IIS........ F................................... .......i3eu....v.1c .�...1..KC..................................... ZILSU ...........
Onsite Representative: ......... o.cI W...... ................................... ............ .. Integrator: .......... CA.t-rdl.s............................. ..........................
Certified Operator:....._................................................................................._..................... Operator Certification Number:...
Location of Farm:
Latitude I 3K _I• 3"S ' ��� Longitude �• [�E' w"
awure
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Number of
General
Holding Ponds
Poultry
Population Cattle
❑ Layer
I—
I
❑ Non -Layer
❑ Other
Total Design Capacity
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Total SSLW L
Drains Present JFO Lagoon Area
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? .
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
ipray Field Area
❑ Yes RNo
❑Yes �allo
❑ Yes [ANo
❑ Yes iI No
AJ =tA
❑ Yes [�t'No
❑ Yes O No
❑ Yes (ffNo
MYes ❑ No
❑ Yes 5allo
❑ Yes to No
Continued on back

Facility Number: 31— 44
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laaoons.11oldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
Freeboard (ft): ...........�.: 7
......................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4
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 ............. his-ki......... ber..muJ.A-
❑ Yes
® No
❑ Yes
B No
Structure 5 Structure
................................................................
6
.................................................................
❑ Yes
®No
Yes
❑ No
�I Yes
❑ No
❑ Yes
® No
❑Yes
ONo
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.violations or deficiencies were noted during this.visit. Nou.will receive no further
correspondence about thisvisit.
any YES answers and/or any
to
❑ Yes RNo
❑ Yes 1g No
W'es ❑ No
❑ Yes ER No
[RjYes ❑ No
❑ Yes EX No
9 Yes ❑ No
❑ Yes [9 No
❑ Yes &rNo
❑ Yes NNo
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field r1um19o4'. (rY'1 k` k, mcords
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 01 /11 lq7

Site Requires Immediate Attention: v'.10
Facility No. 3 I -TOR
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIoONS SITE VISITATION RECORD
DATE: h ' �� , 1995
Time:
Farm Name/Owner: D P F 4 M r� 1f-2 P_' DW R23S
Mailing Address: 393 t-J1,LLA-,e44) kDWFkMDS Re t3@Q"_RvU_e z�sia
County:
Integrator. Ciy-f—�- '­LS Phone: I S - 30 13
On Site Representative.- D SKI 22 t?7> L 1 �5 Phone:
Physical Address/Location: S >Z t 7 a 4-
Type of Operation: S�vitte ✓ Poultry _ I Cattle
Design Capacity: a 8 6 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 4 ' S S 3S Longitude: —1 7 ' 41 I l 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) r No Actual Freeboazd:_Ft. Inches Yes
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? (�r No is the cover crop adequate. �2Nr No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es or No
100 Feet from Wells? Yes or No
0
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or. other
similar man-made devices? Yes ot� If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop) . Ye or No
Additional Comments:
k"i e�I
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

Site :' quires Immediate Attention:
DIVISION OF ENVIRONMENTAL MANAGEMENT Facility No. �L
• ANIMAL FEEDLOT OPERATIIO�S SITE VISITATION RECORD
DATE: t/ / / 1995
Time: .— .
Farm Name/Owner: lI P)ae!lY, ( .n y- 1
Mailing Address:
County: LV
Integrator. rr 0 Phon?(o Z
On Site Representative: Phone:
Physical Address/Location:
o-.
Type of Operation: Swim Poultry _ Cattle
Design Capacity: Number of Animals on Site:
DEM Ce c non Number: ACE " DEM Certification Number: ACNEW
Latitude:' ' " Longitude: 10 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) e or No Actual Freeboard: zZ—Ft. Inches
• . Was any seepage observed from thel�lagoon(s)? Yes or® Was any erosion observed? ( e or No
Is adequate land available for spray? Yes or No I the cover crop adequate? ne or No
Crop(s) being utilized: rm �t /�
Does the facility meet SCS minimum setback crit ria? 00 Feet from Dwellings?'Ys�or No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Jo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or�
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 0 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 'e or No
Additional Comments: �/
V\m
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Atten ' n:
Facility No
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 8- 2'Sr 1995
Time: 'I—yn
Farm Name/Owm
Mailing Address:
County
Integrator. C'a Is o 1 Is,
On Site Representative: E
Physical Address/Location:
Phone:
Phone: 90 a 4&- 30 id
Type of Operation: Swine Poultry _ . Cattle
—
Design Capacity: 0- Number of Animals on Site: j
DEM, Certification Number: ACE DEM Certification Number: ACNEW
Latitude: JTI
Longitude: ' �" sr2,� gZ�°7V ' _43_" 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 Freeboard: 3—Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o< Was any erosion observed?. Yes ortn
Is adequate land available
for spray? or No Is the cover crop adequate? a or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 6 or No
100 Feet from Wells? 6s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(!
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or 16
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or�C If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: 7 .? J
Inspect r Name Signature
cc: Facility Assessment Unit ,; Use Attachments if Needed.

Site Requires Immediate Attention
(s) Facility Number:-24 %76
SITE VISITATION RECORD
DATE: _') - .. r 1995
Owner: ne%fcc Eelw-+-dr Farm Name: _D-P Fir,
County: D of n
Agent Visiting Site: IAOVr+o, Phone: q&o--2A6-.zl.io
Operator:
On Site Representative:
Physical Address: 0/
Mailing Address:
Phone:
Phone: 4 )o -�q j - 343 it
Type of Operation: Swine _y Poultry _ Cattle _
Design Capacity: 9-,? 0_ Number of Animals on Site: .2.8S-0
Latitude: O " Longitude: 0 "
Type of Inspection: Ground -)— Aerial
• Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Sor No Actual Freeboard: 3 Feet D Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
Fax to [phone] U Signature of Agent