310259_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

for Visit:
Inspection U Operation Review U Structure Evaluation O Technical Assistance
Referral
Other O Denied Access
Date of Visit: Arrival Time:Departure Time: 0 a County:
Farm Name: �. 442 y c4i-Riaie rw-tl-7 Owner Email:
Owner Name: 10P y C.4,441 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 30 Q y CA, J¢ r
Certified Operator: '160 Got-ka-
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator: M6 tS
Certification Number:
Certification Number:
Longitude:
Region:
Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Feeder
Non -La er
DairyCalf
Finish
7 p
Dai Heifer
o Wean
o Feeder
Finish
irk
Dr., P,oultr,
La ers
Din
Ca aci
Current
Ho .
D Cow
Non-Dairyo
Beef Stocker
Non -La ers
Beef Feeder
Pullers
Turkeys
Turkey Poults
Other
113eef Brood Cow
Other
El 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)?
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE .
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑Yes NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 13 Did❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EfNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility No ber: E Date of Inspection: _ — 7
Waste Collection & Treatment �-�/ /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes t� N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No ❑ NA ❑ NE
(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 CdNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes ❑ 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 2fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Types) LY1W"J,4 i 5�174110 r9i rt�S
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
%l No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
jrNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
d o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[7�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fWc
❑NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yeso
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C6 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 i Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes En VN(
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility N ... ber: 3./ - 2 SL, jDate of Inspection: -
24. Did thk facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Io ❑ 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? ❑ YesVNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No i NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
2<E
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIviP?
❑ Yes
�❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[3 Yes
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ YesFo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
5(14 d'99- Suv✓Qy v14 46e -I-� ( 00C- 3i/ as f4 0l✓ # 2 ��Fsoa t�.
5 1I7d5e Sur✓¢y It-y-17 btv
0 = 3. sd
p S zy
Soil toS+S /b-6-17
0Q-t1 MAinjt1;4--j / Govd
Reviewer/Inspector Name:
tnjeopi M!
/toms ,
Phone: f 79 1 Y Ze 0
Reviewer/Inspector Signature: �'3 4( S4zsef 7P iwa- (Z A a
Page 3 of 3
Date: / ;� - 1/—/ 7
21412015

Type of Visit: (..,)CO ante Inspection (] Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Vissii_t,:Rooua�tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: /© County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
o'e
Title:
Latitude:
Phone:
Phone:
Integrator: Certification Number: /7 �L
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
Wet Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Qg
Dy P.oultry
Layers
Design
C•_a aci_
Current
P,o ,
Da Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes rNo
NA ❑ NE
❑ Yes❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: 3 1 - 2 45-9 jDateof Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes to
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier: 911
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3
r, e-W
Observed Freeboard (in): _4-
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? El Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 6Zo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No . ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): %
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
J'] No
❑ Yes
[ No
❑ Yes
No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes EJ�No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: / _
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E7 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a min gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number; - Date of Inspection: 'L
17144
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No ❑ NA
❑ NE
25-As the facility out of compliance with permit conditions related to sludge? If yes, check
❑Yes
jrNo ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a PDA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
-
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NAB❑
NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑'NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
M No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[D--No.
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Eo
❑ NA
❑ NE
Page 3 of 3 21412015

Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:.1 O 0 O Departure Time: O 9 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: a 4 TC/
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: I % y Zr->
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
11-ayer
Design
Capacity
IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
We o Feeder11
jNon-Layer
I
airy Calf
eedertoFinish
'
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oultr.
Layers
Design
Ca achy
Current
Pao ,
Dry Cow
on -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
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 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 Q-go_ ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes [—]No
❑ Yes [-]No
[-]Yes Q 0
❑ Yes El -No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: 2 Date of Inspection: 151 z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D-ITo- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l 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 E35o ❑ 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
'No 7. Do any of the structures need maintenance or improvement? ❑ Yes ❑❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ 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 ffNo ❑ 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 CAW MP?
❑ Yes
Q'No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O'No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ 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
E 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 ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard , ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes - ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24 Did th facility fail to calibrate waste application equipment as required by the permit? El 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?
F'r,,/rec9c6S l9'FT o
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
d'
No ❑ NA ❑ NE
Io ❑ NA ❑ NE
❑ Yes
[3'No
❑ NA
❑ NE
❑ Yes
[-]No
/ NA
❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes CTNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Ef;❑ N NA
El Yes No NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
Phone: 'I 42VFGTJ0y
Date: + n 2 7 l�
Page 3 of 3 21412015

Division of Water Resources
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number.
310259 Facility Status: Active
Permit: AWS310259
❑ Denied Access
inpsectlon Type:
Compliance Inspection
Inactive Or Closed Date:
Reason for Visit:
Routine County:
Duplin Region:
Wilmington
Date of Visit:
10/29/2015 Entry Time: 10:00 am Exit Time: 10:50 am Incident S
Farm Name:
Joey Carter Farms
Owner Email:
Owner.
Joey D Carter
Phone:
910-2985360
Mailing Address:
140 Miller Rd
Beulaville NC 285188861
Physical Address:
175 Joey Carter Ln
Beulaville NC 28518
Facility Status:
❑ Compliant ❑ Not Compliant Integrator
Murphy -Brown LLC
Location of Farm:
Latitude:
34' 54' 59" Longitude:
77° 49 52"
West of Beulaville. On North side of SR 1961 approx. 1.2 miles East of SR 1800.
Question Areas:
Dischrge & Stream Impacts
Records and Documents
Certified Operator.
Secondary OIC(s):
Waste Col, Star, & Treat
Other Issues
Waste Application
Wells
Operator Certification Number:
On -She Representative(s): Name Title Phone
On -she representative Joey Carter Phone:
Primary Inspector. David Powell Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
Farms / records look good.
I
page: 1

Permit: AWS310259 Owner - Facility : Joey D Carter Facility Number: 310259
Inspection Date: 10/29/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operation: Design Capacity Current promotions
Swine
Shine - Feeder to Finish 4,740 2,245
Total Design Capacity: 4,740
Total SSLW: 639,900
Waste Structures
Type IdeMNler
Dlsignated Observed
Closed Date start Date Fero Freeboard
Lagoon
1
19.50
41.00
Lagoon
2
19.50
41.00
page: 2

i
Permit: AWS310259 Owner - Facility : Joey D Carter Facility Number: 310259
Inspection Date: 10/29/15 Inppecton Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
M ❑
❑
b. Did 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)
❑
M ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑M
❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
0110
State other than from a discharge?
Waste Collection. Storage & Treatment
yes No No No
4. Is storage capacity less than adequate?
❑
❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not property addressed and/or managed through a
❑
M ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
0 ❑
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
Cl
maintenance or improvement?
Waste Appticatton yea No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ No ❑
maintenance or improvement?
11. Is there evidence of incorrect application? 0000
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS310259 Owner - Facility : Joey D Carter Facility Number:
310259
Inspection Date: 10/29/15 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes
No Na No
Crop Type 1
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
01111
Management Plan(CAWMP)?
15. Does the receiving crap and/or land application site need improvement?
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
E ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
N ❑
❑
18. Is there a lack of property operating waste application equipment?
❑
NoO
Records and Documents
Yea No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
E ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
N ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑
NoD
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

f' Permit: AWS310259 Owner - Facility : Joey D Carter Facility Number: 310259
Inspection Date: 10/29/15 Inppection Type:Compliance Inspection Reason for Visit: Routine
Records and Documents
yes
No No No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1' Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0011
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
01111
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
01111
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
01111
appropriate box(es) below.
Failure to complete annual sludge survey
❑
Failure to develop a PDA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
M ❑
❑
27. Did the facility fail to secure a phosphorous loss assessment (PLAT) certification?
❑
110
❑
Otherlssues
yes
No No No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
N ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
M ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
01111
(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
❑
If Other, please specify
32. Were any additional problems noted which cause noncompliance of the Permit or
❑
M ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
1101111
page: 5

I
Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: \\ __ /V Arrival Time: Departure Time: 70 County: (./N
'Farm Name: JCJ� �19VM S Owner Email:
Owner Name: �OrL M� �A� (t��� Phone:
Mailing Address: I LI O V(� , EN LO O I LL C ,1V C CDFS/ g —<f
Physical Address:
Facility Contact:
Title:
Phone:
Region:
Onsite Representative: Integrator:
�� Vl 9015 I his o1O
Certified Operator: � , �A� 1 C� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design C•uceent
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
Wean to Feeder
I jNon-Layer
I
I Dairy Calf
Feeder to Finish
N O
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
D , P,oul . +
Layers
Design
Ca acit
Current
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Pouets
Other
Beef Brood Cow
Other
01 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 XNo
❑ Yes [—]No
❑ Yes ❑ No
[—]Yes [:]No
❑ Yes � No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

:
Fai: ClumCbe . ' 3 1 Date of Inspection: ( $ J
Wasta Collection & Treatment U �/,
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I / No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes T❑�No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �_ 1
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
I Y 1 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ICE 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 17U No ❑ NA ❑ NE
maintenance or improvement? `Y
Waste Application ,,..,(
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I �/I No ❑ NA ❑ NE
maintenance or improvement? 7�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes K%I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))'
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): {.2_C 2 I L S.1AC
13. Soil Type(s): ? (.}UMLC ws AN�ICAU It t E
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 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
y�
❑ Yes I Y I No
"'tttfy(ttt"'
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists QDesign QMaps ❑Lease Agreements
❑Other:
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ �{ Yes IX
I No
❑ NA ❑ NE
0
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 No
❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number:4 1 - Sq Date of Inspection: U
.24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �j No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes I AI No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes TR�$tlNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
777"""ttt
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
tom,
t 7,t No
T�
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[� No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
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).
ao1y
SLJ.-.o4G su���� cx iy
w A- 1 rD
IoI--:V]iL4 I.66 1 53
I9whN /-NS I �8
31�9/ILI J.&O Ci(a
So crO►N
Reviewer/InspectorName: F Phone: /16 --196-W8o
Reviewer/Inspector Signature: _ Date: // /
Page 3 of 3 2/4, 2014

Type of Visit: la Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 2F Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: (® Departure Time: -"-
County: U ahf
Farm Name: MC,�}QJ/ti, tclte�•L / �•YVY\� Owner Email: ��—
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region: 1 4
Integrator:
Certification Number:
17Y,a� a�i3
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle C•apacfty Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,ouI
La ers
Design
Ga aci
I
rfrent
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El Other l IOther
Turke s
Turke Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[:]Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Pagel of 21412011 Continued

' Eacili Giumber: 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: Li a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5 19 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
m 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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
m No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Vf 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
m No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1Z] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Vjr No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t-�
[ No
❑ NA
❑ NE
Reunited Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z 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 �jNo ❑ NA ❑ NE
[:1 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V] No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili `,Number: j jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
pr
❑ 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
PI No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
P No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�-�( No
YJ
❑ 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
17 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
1
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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes La'No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Z No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
7wS)F;;Z�N k'� o"�
Phone: rerI -w:2 =5b
Date:
21412011

Reason for Visit: 4 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 -Dnenied Access
Date of Visit: Arrival Time: he
Departure Time: County: l X_(�L!/1G" Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative:
\ 21 Integrators:
Certified Operator: �Q — 2� ' Kon Number: l� T oC
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design C•unrent
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
�/
D P,ouI
Layers
Design
Ca aci
Current
P,o P.
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
NJ Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any pan 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 pan 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
[—]Yes [-]No
❑ Yes ��❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page of 21412011 Continued

Facility Number: 1-3 ( -195 jDate of Inspection:
Waste Collection & Treatment t
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _I .� 9.5
Observed Freeboard (in): _ !)_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes DO No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) ✓✓✓"���
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes `'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
�
❑ Yes 1�/I No
(
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
e
[—]Yes KNo
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window❑ Evidence of Wind Drift❑ Application Outside of Approved Area
12. Crop Type(s): ���//�� l xj yC �P� �6SCLA.E �'f�
13. Soil Type(s): A
u iaR uI L_(-.0 P&�-zO L.(Av-S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 54No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes I No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ipNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 'y 1 No
❑ NA
❑ NE
Required Records & Documents
T�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
0 WUP ❑Checklists D Design 0 Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �'%No ❑ NA ❑ NE
Q Waste Application ] Weekly Freeboard Waste Analysis Q Soil Analysis ❑ yaste Transfers Q Weather Code
Q Rainfall ❑ Stocking ❑ C%rop Yield 0120 Minute Inspections Q Monthly and V Rainfall Inspections © Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes It No ❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Num er: jDate of Inspection: k
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNo ❑ 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 XNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ANo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
py I No
❑ NA
❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
[]Yes
WNo
❑ NA
❑ NE
❑ Yes
6;�rNo
❑ NA
❑ NE
(Comments (refer to question if): Explain any YES answers and/or any additional recommendations or any other comments. I
Cz
Use drawings off facility to better explain situations (use additional pages as necessary).
�.1WOC1� MOueb cF 2zm C'4LC00N :# P'� eccx: i QS
)JIgall,
EXGw�P � L ryN)�
Poi
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: OC
2/4611

Type of Visit: M Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: .Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: y 1 t Arrival Time: ® Departure Time: County: UN Region:
Farm Name:_ CjC(_A \`1 E�_ ';PAM S Owner Email:
q/O-Q98-u 194 h
Owner Name: E LA ij . CQQ_TC- 2 Phone: qtp- a4Q _ (5�3c
Mailing Address: I "1L-� I t t I L-(_& 2 Rj \�reuL-AU )Ll_F_ / re oL 0 S' Zi —6TS I
Physical Address:
Facility Contact:
Onsite Representative
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
: SOL
A C AR.T g_ Integrator:
all
(Z I Certification Number:
Certification Number:
Latitude:
Longitude:
►_T�fao
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
I
INon-Layer
IDai
Calf
Feeder to Finish
Q
Dai Heifer
Faaow to can
Farrow to Feeder
Farrow to Finish
Dr P,oult ,
Layers
Design
Ca aci
Current
P,o ,
Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPuults
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 A�No ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
[]Yes [:]No
[:]Yes N No
❑ Yes Pd No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Pagel of 21412011 Continued

Facility.Number:: -;k I `I Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ► 9.5 I q .S
Observed Freeboard (in): 31_
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes EA No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) EA
No
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 T' No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes-' No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes {]� No ❑ NA ❑ NE
q maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes qNo ❑ 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 n ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 5 G EL 1Z Fe s c_ .,IE
13. Soil Type(s):
14. Do the receiving crops differ from -those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
IM No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
`Q No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Ye INo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
QWUP QChecklists QDesign ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application Q ,W/eekly Freeboard Q Waste Analysis Q Soil Analysis ❑)Vaste Transfers Q Weather Code
Q Rainfall ❑ Stocking ❑ yrop Yield ❑ 120 Minute Inspections Q Monthly and V Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: ( - S`1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
If yes, contact a regional Air Quality representative immediately. 7�
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No
permit? (i.e., discharge, freeboard problems, over -application) ,r-I,
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionalrecommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary). t
S�,o�E exEMp� �u7(L a��3
►ac�7,oN �u� aGr
3�311av► 1. S
c IS►o� � �o�E�- a � a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910- }9t9 1'7
Date: ah L/ '
21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit WRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ,�y/p 1 Arrival Time: Departure Time: County: Qt--� N Region:
Farm Name: _.J\\C)EH Cacz I cy - �(�l2(YlS Owner Email:
\ - q16- $-4I94Cul
Owner Name: J�Et���` (,� E Phone: 91p0-oi98-ST4oCW)
Mailing Address: )"2J 1' 1IC.LCt2 pplw UELKLAUILL,/AI)C
Physical Address:
Facility Contact: Title:
Onsite Representative: _\oeC1-1(-T 1�_
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
[ntegr01(2:
Operator Certification Number: �g�0
Back-up Certification Number:
Latitude: = o = 1 = " Longitude: = o = ,
Design Current
Design Current
Design Curren[
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑. Wean to Finish
10 Layer
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
10 Non -Layer I
91 Feeder to Finish L40
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow Farrow to Finish
❑
❑ Non -Layers
❑ Pullets
El Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
Number of Structures:
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
12128104 Continued

r+
Facility umber: 3 J —a599 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ElNA [INE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Strucipre I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:E �F
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [INA [INE
(ie/ large trees, severe erosion, seepage, etc.) '�.,\(
6. Are there structures on -site which are not properly addressed and/or managed El Yes 17(1 No El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ 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
El Yes
������,,,,,,,,,,,,((((((
P
No
❑ NA
[I NE
maintenance or improvement?
\\
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
[INE
maintenance/improvement?
+1
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
1ANo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �Jl' l 4� r �P� P_Z_C-UL LL
13. Soil type(s)
TouuS
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 9No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
IT Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1� No ❑ NA ❑ NE
9No ❑ NA ❑ NE
;kNo ❑ NA ❑ NE
Comments (refer to question
#),Explain any YES ,an wers and/or_any recommendations�or an} othe'i=o" mme"n' f�s'
Use'drawin s offacilitY"to better explain situations. (use adddtonar& es as; nee-'rY)
Reviewer/InspectorName
Page 2 of 3 12128104 Continued

f\
'Facility•Number: 1 — a59 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes p
f *o El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes
//W```No ❑ NA El NE
the appropriate box. ElWUP ❑ Checklists El Design ❑ Maps El Other
�l
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ✓✓✓✓✓�No ❑ NA ElNE
❑ Waste Application ElWeekly Freeboard ElWaste Analysis 0 Soil Analysis El/aste Transfers TV
ual Certification
0 Rainfall ElStocking ElCrop Yield El120 Minute Inspections 0 Monthly and I" Rain Inspectionseather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
L41sl�v
-3 j 1 5
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
o
El NA
❑ NE
ElYes
to
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
ElYes
ANo
❑ NA
❑ NE
❑ Yes
P(No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
ElYes
to
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit x Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ) Arrival Time: ® Departure Time: County: 1 W Region:
Farm Name: JOCu C A�3E� `-A2(�5' Owner Email:
\ - ` Wl9lo 9& LI194
Owner Name: . X3ec U I� • �i�� ?�2 Phone: QW) 9/0 54 toO
x /_ __ -." - - -
Mailing Address: I L-J( �) 10 11 L-L— « It 10 `i F-U-LP U I UJr— / 1l L Zh/6._1a
Physical Address:
Facility Contact: %1 Title:
Onsite Representative:��-
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 11 Q a 6
Back-up Certification Number:
Latitude: = U = ' = Longitude: = o = ,
` Design .� Current Designt�. Garrent Destgn Current
Swine - Capacity Population •. Wet Poultry Cap_actty Population ^Cattle i;^ . "Cq aci ` Po ulation "
❑ Wean to Finish
❑ La er
I
[I Dairy Cow
ElWean to Feeder
I
I
- ❑ Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish Iti ti0., < kr, w. ; •v :;`'`4
^'..*
ElFarrow to Wean n, " r
D Poult
El Farrow to Feeder "
.,. ❑ El Layers
to Finish
El- Gilts ¢ ❑Non -La Non -Layers
❑Pullets
❑ Boars
❑ Turkeys
Other 0 Turkey Poul[s-
❑ Other ❑Other
— — T.7—
'"°••^
a.
'"•
❑ Dairy Heifer
; ❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
� El Beef Feeder
❑ Beef Brood Cowl
'
a.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
IXNo
❑ NA
❑ NE
❑ Yes �ko ❑ NA ❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 St re re 2 Structure 3 Structure 4
Identifier: / N6� oL OLD
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y 9 t /�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
J�,No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the strictures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) tr,�
9. Does any part of the waste management system other than the waste structures require ❑ Yes l 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 „XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [I Evidence of Wind Drift [:]Application Outside of Area
12. Croptype(s) SG &,g&(� (?)
13. Soil type(s)
Lk
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,qJ 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
ONo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
,XNo
❑ NA
❑ NE
Comments (refer•to question W): Explain a`nv YES answeis an'd/driany recbmmendahons'dr nny, oYfie comments °"^'� } ' `"��'
Usedrawings of facility to better explain situations. (use additional -pages as'necessary)� a
e.
Reviewer/Inspector Name Phone: g10 14 (o -3p1�
Reviewer/Inspector Signature: Date: jail i oci
12128104 Continued

�J
Facility Number: a93 Date of Inspection / U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropriate box. 0 WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA
❑ NE
///
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ caste Transfers
❑�&ival Certification
❑ Rainfall ❑Mocking ❑yrop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
WNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ 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
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
, ,((((
,\
�rrr[���Jttt No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ta,t 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
gNo
❑ 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
E�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
d� No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�
❑ NA
❑
NE
Addrtiona4Co_ mments,and/or
12128104

n Division of Water Quality
Facility Number 3 � a•5q 0 0 Division of Soil and Water Conservation
-- -- — 0 Other Agency
Type of Visit J& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit x Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �% f O$ Arrival Time: / C7U Departure Time: County: Lf/V Region:
Farm Name:
Owner Name: )OStA Clan-TEp—
Mailing Address:
Physical Address:
Facility Contact: ` Title:
Onsite Representative: _�BcCA(LT —(Z
Certified Operator: UE CA4LTER
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: 1 —4g«(2)
Back-up Certification Number:
I--]" Longitude: =o=` ="
Design Current. Design Current
Capacity Population Wet Poultry Capacity PopulationCattle
❑ Layer I I❑ Dairy Cow
❑ Non -Layer I 1 10 Dairy Calf
iUl9 UVn/1 — — F-1 n.,:ry Heifer
Cow
Dry Poultry
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design
LI Beef Stocker j
❑ Beef Feeder
❑ Beef Brood Cowl I I'
Number of Structures: =
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
�(No
❑ NA
❑ NE
12128104 Condnued

Facility Number: 3 I —a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No El NA ❑ NE
a. If yes, is waste level into the structural freeboard? ElYes ''❑ No ❑ NA ❑ NE
Structure 1 Strure 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
D(I 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
QNo
❑ 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
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
KNo
❑ 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
allo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes
,.,,(
%J No
❑ NA ❑ NE
maintenance/improvement?
,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
J)�No
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
\
[]PAN ❑ PAN > 10% or 10 lbs [:)Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes]
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
Mf No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
X No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or
Use drawings of facility tobetter explain situations. (use additional
FINn CopvsoF COG 't �Leco2bs J
know I- I -/It: ar_T oN w SitND I
ecessary): I
IF C—ANNor I_ET ME `
Reviewer/Inspector Name 4/_ j Phone: 'I/0- 17(o�Y�d i
Reviewer/Inspector Signature: 0 Date: y Date: —/�/-7�0?/-7�0S
Page 2 of 3 12128104 Continued

L
Facility No Date of Inspection
Required Records & Documents ppp {{{
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes b[I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElO` Yes ' No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues .
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency? '
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
y�No
❑ NA
❑ NE
❑ Yes
[ANo
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
VI No
❑ NA
❑ NE
El Yes
,KNo
[I NA
[I NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
P�No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
[t7 No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number % ( :1$ r1 O Division of Soil and Water Conservation /
O Other Agency V
Type of Visit ercompliance
Inspection
Q Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up 0 Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: ETp,
�Arrival Time: i :'-1 S Departure Time: County: DUPL.LJ%) Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: 34Y CARIEE-c
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = ' = Longitude: = c = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
4146 IUU60 I-
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
othedthan from a discharge?
■
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

rVacility Number: 31 — aSq Date of Inspection 4 la O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ 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: L19Goo0 I L_AGaonl Z
Spillway?:
Designed Freeboard (in): l4 S t9.,
Observed Freeboard (in): 4 S 3 g
5.
Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
B 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
E�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
❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
1[2'Ro
E I 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
CJ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Uo<o
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
2 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
B No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
BrNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
El NA
[I NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
,,El'No
Cf--NNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
L,I o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r
Reviewer/InspectorName 3 Phone: Rl 7Q`--7388
Reviewer/Inspector Signature: Date: 4 a
12128104 Continued

Facility Number: 3 ( as Date of Inspection 4 iS a
Reauired Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes <o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists Design ❑ Maps
❑ Desi p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U<u
❑ 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
O No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
❑ Yes
O NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
21 o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O� NNo�o
El NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
[2 o
❑ NA
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
O NNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
,�
L�SNo
❑ 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
ElYes
2 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
P o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2<
❑ NA
❑ NE
Comments and/or Drawings:
12128104

of
Division of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency .
(Type of Visit CftooJ_npliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit �!J Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: DUEUT-IJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J DE-? CAPTea_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Longitude:
0
Design Current Design Current . Des]
Capacity Population Wet Poultry Capacity Population Cattle Capa
in to Finish ❑ La er I I ❑ Dairy Cow
an to Feeder r- ❑ Non -Layer I I ❑ Dairy Calf
der to Finish 114 P)gro I 3 O ;`,: ❑ Dairy Heifer
:ow to Wean 1 .Dry Poultry ❑ Dry Cow
vumr
❑ Other
❑ 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)?
Number of Structures:. _L
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 2<10 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes EfN ❑ NA ElNE
El YesVNo ❑ NA ❑ NE
12128104 Continued

Facility Number: —2 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 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: CA GOC-) A) / A LOON 2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): i
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
❑ Yes dNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
AIo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
V 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
ONo
❑ 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. Oyes
No
❑ NA El 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 El Evidence of Wind Drift Application Outside of Area
-Window
//
12. Crop type(s) z' WJ
(❑
r eS C.1%� J G 0
13. Soil type(s) A JTo-�?U.SL U r A Lt a
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O<o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
LNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[Z No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑Yes
LaNIA
ElNA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
ElYes
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):
21,) C AF "SEt rJ OECOS To 3E JeIJA-t" WA&CJ SEtw V, auP �S GitAiED.
Reviewer/Inspector Name r Aa Phone: 010- `76 -13 U
Reviewer/Inspector Signature: Date: (Reviewer/Inspector Signature: Date: l qJ 1 k&&
l Y�C G Vf J 1L/LV/V7 li Vi�asi�YGu

. .. . i.L'
Facility Number: — Date of Inspection to d(p
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
UN o
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2(/No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
[Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis El Soil Analysis [I Waste Transfers
El Annual Certification
[3 Rainfall El Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspectionss
Weather
Code
�❑
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L�2 NNo
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
El2
,LEI
NL
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
U
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
_N�,o/
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L=1 No
❑ NA
❑ NE
Other Issues
�/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
N
[I NA
[I 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
dNo
❑ 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
ElYes
0 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
0<(
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit l9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l Oj Arrival Time: JJ6l} Departure Time: County: PO Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: • I OE'1 CIA«1Teft— •
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
1 ,
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Laver
❑ Wean to Feeder ❑ Non -La ei
® Feeder to Finish I q7 LIO I qS 5 b
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
'
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
[:]Yes
❑ No ❑ NA
❑ NE
0
❑ ❑ NA
El NE
❑ Yes
❑ Yes
Q ❑ NA
❑ NE
❑ Yes
L.tavo ❑ NA
❑ NE
12128104 Continued

}
Facility t tuber. 31 — 29
r
Date of Inspection 31 OS
waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I,AG 0 I (.,fsC,0-ot1 7—
Spillway?:
/—
Designed Freeboard (in): 101.13 { q• l
Observed Freeboard (in): lg s 3`4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes / No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes L/J No ❑ NA ❑ NE
❑ Yes 0No ❑ 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 �, NNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes CVNo ❑ 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 VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
,..,(/
YJ N ❑ NA El 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 Ibs ❑ 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) &-t}. MUM q Cr—) SGO �C%C-0 e CGS
13. Soiltype(s) AV ;IzqJ.Lo_fc c_ ows
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
N ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes/No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination , ❑ Yes
O NNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes
LJ N ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA ❑ NE
Comments�(refer'to question � cEaplam any�YESranswerstand/orany recommendations or any other comments.
U s wtu s of facrlt +to+better ex ►atn situations use addthonal a es as necessa .
:.oi3swe�*�' xmss.a
'�A,) NPJE 54 W CoMAL't(_'i T�L. ?0.0,j R.•A TC� o i L.JJP
f-Arts,, APO QECO"S LIOOK- CroaD.
IReviewer/Inspector Name 1 o" t{ �) , `I Phone: qlD) 7g�2 —7a 6 I
Reviewer/Inspector Signature: 9JDZ An AIA." Date: Ell SI foS
12128104 Continued

• FacilityumbDate of Inspection �toS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes d o ❑ NA ❑ NE
20. Does the facility fail to have components of the CAWMP readily available? If yes, check [i] yes ❑ No ❑ NA El NE
the appropiate box. WUP ❑ Checklists
❑ Design ❑Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LI 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
EfNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ENo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
- ❑ Yes
Z NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,,,1__�d,,///No
E2
ElNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El' Yes
o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ko
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
— /
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑Yes
O
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
9No
❑ 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
•" N
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Commentsaand/or, Dmwings: _ ; w x?y x l64,
12128104

of Visit ;6 Compliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit f019outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number •• Date of Visit:
Permitted CCe-rtified ❑ Conditionally Certified E3 Registered
Farm Name: ...c.).)-e. Q 11....Fa%.m.a................... - .... ..-
Owner Name:... Q.....1 Q.C._! ......... __......
MailingAddress:..___._.__---......._._..._...._......._.___..._.________.__.._...._._
Facility Contact:
Title:
Tune:
Date Last Operated or Above Threshold:..
County:.A.�.t 1........ ..... _......
Phone No:
Phone No:
Onsite Representative:., Q. J._fQc1c.''--......_........___..__.___._.. Integrator. _Pf e (tinf_IA.Y.1.1...S.' 1YAp,.f...t..
Certified Operator:
Location of Farm:
Operator Certification Number: ..................... ...... ... ........
MSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude F_�• =' =" Longitude =• =' =11
Wean to Needer
- eederto Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _......_......... _................... _.......... _ ... .... ... ........... _......... _................................. ...... __................. ...... .
Freeboard (inches): 3,s- 3
12/l2103
❑ Yes Z tvo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
[]Yes L�o
❑ Yes P No
Structure 6
Continued

Facility kumber: 31 — Date of Inspection $
5: Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
2rf4o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
01lo
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
&No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VrNo
9. Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑'90
elevation markings?
Waste Application
10. Are there any buffers that need maintenance./improvement?
❑ Yes
B'No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
014o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
1
12. Crop type ('.,a.s �`T3eCMA40, � Ncu � S [i,� O, -c. t✓t i Qycc5'e'QotJ
t
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
0 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑190
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
LJ-No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑'ilo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
W10
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
ErNo
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
PIo
Air Quality representative immediately.
,Comments (refer to question #)�Ergilam any YLS answers and/ar any iecomme`ndahoas or any othe?comments. _ ,
Use drawings oi' �cdrty to better explain �luatro 'ens. ('ems. ase addthonal pages as necessary) -� Field Co � �a�
1❑ Py ❑
ores
Reviewer ector Name
Reviewer/Inspector Sigrratu e: Date:
.w.civa c-onnnuea

Facility Number:. —2 qj Date of Inspection ,$
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
;afgo
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
Of4o
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ONo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
E No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[a'No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑'No
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
014o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
LNo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P'No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
;CrYes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C''10
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑'&o
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
dNo
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
[�VNo
❑ Stocking Form ❑ Crop Yield Form []Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditional Comments an'd1or Drawings y
have 4yr1,r4oikVy c�L ,4-5 wig .records
Yyk t re cords are-
yi-e �- G`��`�ly
12112103

Type of Visit .0 compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Rl Routine 0 Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number H=11
Date of Visit:
O Permitted [3Certified ,Q ondiitntionallllyCertifi D,, RRegistered
Farm Name: F`�Yilt t\I'�
Owner Name: T
Mailing Address:
Date Last Operated bove Threshold:
County: _
County: t°G 0Ie
Phone No:
Facility Contact: ���,�,— M Title: - f,d hone No:
Onsite Representativecl�_ �F� 1 t �%rIE'Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
IIp swine ❑ Poultry []Cattle ❑ Horse Latitude =' =, =- Longitude =' =I =-
Current
Feeder to Finish /�"fCj/J
Farrow to can i
Gilts
Cattle
❑ Other
Total Design_ Capacity
Total SSLW
Waste
Discharges & Stream Impacts ,..,(
1. Is any discharge observed from any part of the operation? El 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 Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ,❑l No
2. Is there evidence of past discharge from any part of the operation? El Yes ,,,I���No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El /iQ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
StruFture�I S ture 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: W/ ajo
Freeboard (inches): 0
05103101 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
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
No
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?
El,.,..,/
Yes
l� No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
o
Waste Application
10.
Are there any buffers that need maintenance/improvement? -
❑ Yes
11.
12.
Is there evidence of over application?, I Excessive Ponding El PAN [I Hydraulic Overload \
Crop type \jiQmdnA- /F{Au �mF�, / lIX424i 11)vAe4'ff_-D 1
El Yes
,..,(No
ILJ No
13.
Do the receiving crops differ with hose desiAdled in the Certified Animal Waste Management Plan (CAWMPf?
❑ Yes
Q� No
14.
a) Does the facility lack adequate acreage for land application?
El Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
El No
15.
Does the receiving crop need improvement?
❑ Yes
ANo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
�ZNo
_Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
,.,../'
IQ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
Yes
El/�
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
,V(No
o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24.
Does facility require a follow-up visit by same agency?
❑ Yes
,,,...///No
Ld No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�"
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ea a '" n :tw; _. - :3 x;, r, ,.. ,
Gbmmeots{refer io,question Explain any YES answers and/or anyrecommeodahons oi•any other comments "?'a' '
n`"'�
Use drawings of facility in better explain situations. (use additional p ges as'necessa`ry)
.. ,14- , ia. s-Field CoDY ❑Final Notes '
_.. , -
/`� EEp �y�ATzo.✓ �SzC� /� s!-lC R�Fr✓7
Reviewer/Inspector Name I
Reviewer/Inspector Signature: Date: 7i
05/03/07 Continued

Facility Number: — Date of Inspection�/"`/(/!�l'
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
ElYe No
❑ Yes YNo
xj�El Yeso
❑ Yes No
El Yes No
Additional Comments and/or Drawings:., , . r.
/fD7� : ✓�,2,r}{� G �� � 5 � c f ,&GL f�-ZiJ 9f�Zr�
���� �� r" L�RGI7/}�f) �'07/fE� �fh�.EG�i✓� �t//✓a
r� &
05103101

Type of Visit ,OrCompliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit,-0Moutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: B 7 Time: (Z O
Q Not Operational Q Below Threshold
0 Permitted [3 Certified 0 Conditionally Certified 13 Registered
Faun Name: _......................CCaA ..-.4.4( C r. �n...^...5..............................
OwnerName:.................. ° e `....................................................................................
Facility Contact:
Mailing Address:
Title:
Date Last Operated or Above Threshold:
County:..57�.✓...................................
Phone No:
Phone No:
Onsite Representative: _J �.l G r g I ¢ n , ✓ - A p'q ^Ay
Inte rator:................................................1..................... ............ _..
Certified Operator:
Location of Farm:
Operator Certification Number: ..................... . . .................
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude Longitude =' =, =..
Design Current
CaDRCitV PODDIatiOD
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Ca aci : Po ulation Cattle C
❑ Layer ❑ Dairy
❑ Non -Layer 1 10 Non -Dairy
❑ Other
Total Des_ ign Capacity
Total SSLW
Number, of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area JE3 Spray Field Area I
holding Ponds/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: F0..P..M.,
/' ^^�.........................................................................................................................................
.............
Freeboard (inches): 4G 4 6
S/00
❑ Yes oNo
❑ Yes No
❑ YesrNo
IIIDl
❑ Yes'] No
❑ Yes�No
❑ Yes Y-No
❑ Yes T No
Structure 6
Continued on back

Facility�Number: / —2 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Z'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_.13'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes EfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes M-No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes _]•No
11. Is there evidence of over application? ❑ Excessive Pondding ❑ PAN ❑ Hydraulic Overload ❑ Yes 13'No
12. Crop type &,- Y-1 I/ X-' A. `j , S"M4 / I
13. Do the receiving crops differ with those d9signated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
)Vq.*i0F;100rW0r- dgfjcie�tcies •w$re pbted ditriitg tbis'visjt; • Y;ojt witl•SecQiye tjq fpstbt�f • ;
eoriesborideitce: abiy6f this visit:
❑ Yes O-No
S/ tq
[]Yes ApNo trq. e
❑ Yes ❑ No 6/4nt
❑ Yes ❑ No
❑ Yes,�No
❑ Yes',,eNo
❑ Yes Jallo
❑ Yes,)3'No
❑ Yes)a'No
❑ Yes j2No
❑ YesP'No
❑ Yes 1 No
❑ Yes )Z�No
❑ Yes o
❑ YesZgNo
I sem 4a to,-vol v, �y, A ><¢�G,;cet� Spec{Rl s{ -fa oval v4e zueetN4 w4s)e `
P)^n i AQ" A'- d,'.rerepaYtc,'es be4ween 44Q, aeveaje Pitgullj sti.twn ,h
e L'V 45.4e plate versus ��,e i�/,'9k{;o+� de's9n. `7�tie CDrteL��Greq�e v)ee�
->e bew de4e,-m,n-A a)iA 44;s A"t1d be used tva54¢ p)ar, and
oh 44e -f121z-2's. `�
ge sv,-e 4e u,<e A- wA-ge An-1I �.�
clpy1,•ca-E�etiv eewls eh �
-Ae re1? 'S• /
Reviewer/InspectorName pyCt+l,1
Reviewer/Inspector Signature: t q'Vylw Date: O 1 smo

Faci;ty Number: — 25ql Date of Inspection 8 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ YeSJallo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes G1 No
roads, building structure, and/or public property) T
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes _,EI'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes_.ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes _,2rNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes []No
I -Additional Comments and/orDrawings: -t _
The Ac(l;f 7/ crolos, o,no( Deco,-etr qie Lvell kept. s�, nay C1iV cat�;oti
& on501"t) as -T 6 ve bean ALV ;nsPecl,oh; �,Q /a��ltcai;6h
is ) e, ") well.
5/00

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �'�.O Time: ® Printed on: 7/21/2000
®--�
11 Q Not Operational O Below Threshold
Permitted E3 Certified [3 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .......................
FarmName: .... _G..._.'.:..:............................................................. County:........�\'y'1........................... ....................
OwnerName: ................................................... ................................................... .................... Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: ..................................................................................................................... ..................................................................................... ..
........................
Onsite Representative:.... Qr.......................................................................... Integrator:....._.6�GS/c...................................
Certified Operator: ................................................... ................... ......................................... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �^ Longitude =• =' ="
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Po Elation Cattle Capacity Population
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish 0 ❑ Non -Layer ❑ Non -Dairy
Farrow to'
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Subsurface Drains Present IILJ Lag,�-n Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
WNo
Discharge originated aC ❑ 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
WNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): NS Lh
5100
Continued
on back

Eacifitj iN'umber. �j 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 ,KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes XNo
(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
A�No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[XNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
TKrNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ONO
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
�TNo
12. Crop type '✓_'� , S'Ep
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ffNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
9No
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
,ty No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
J9No
Required Records & Documents _
17.
Fail to have Certificate of Coverage & General Permit readily available? -
❑ Yes
ONo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
ONO
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
RINo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JgNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
fie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes XNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ONO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes fXNo
E dVq•violataris:oT deficiencies -were itofed ditriitg this:visit: Yoit wi11te0h iq cio: further.
cories oridence: about. this vtstt.. .
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):
/ �/' __g5it
rl
Reviewer/Inspector Name
ReviewerQnspectorSignature: Date: Q h—W 5100

kacHkty-Number: — Date of inspection Printed on: 7/21/2000
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 9Jor below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
tion_ a :Comments and/or Drawings:
_
�.. ;
�
A�-
5100

.n
0 Division of Soil and Water•.Consetvation= Operation ReJiew -. • _. �'--=
E3 Division of Soil and Water Conservation - Compliance Inspection
Division of Water -Quality '-Compliance Inspection
m =
Other Agency - Operation Review
Routine 0 Complaint 0 Follow -tip of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection /
Time of Inspection 24 hr.
Q Permitted � Certified ❑ Conditionally Certified ❑ Registered ❑ Not O erational Date Last Operated:
1 � ��, r ..........................
FarmName: ..........._vS ....j..�.`Il . t ! ...../..`._t-GYP.yS........_................................. County:....... �1.t>...................................... .......................
Owner Name: ..........................c:1D.:fls�................L.k.•7c.!iV............................................... Phone No: ... .('1io.1..zq.8:n4.M..........................................
Facility Contact: l Title: Phone No:
Mailing Address:..... 2_?_.......Ps�T.....�!.�,-:.....�.1(.....'I......-�1'_1/..W.V.t..�l......N:................................. ._1.�.
tt{��� ��� 1.................................... ` ..... .......
Onsite Representative: ............. 1�!.1 ea......... w................................................... Integrator: ........ U.Q.Lltip.QW.........................................................
Certified Operator: ..............................1.................................................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude F1• 01=1 Longitude =• 0' 0.1
unum i apacuy rupumuun
❑ Wean to Feeder
Feeder to Finish 14 7 qO LA ly
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I[] Dairy
❑ Non-LayerI IE]Non-Dairyl
❑ Other
Total Design Capacity o4o
Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
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 Waters ❑ Waters of the State
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:N.IpJ
Freeboard(inches) ............� ..............................3.....................................................................................................................
❑ Yes ['No
❑ Yes [;INo
❑ Yes [50 No
Njk
❑ Yeses (A No
❑ Yes W No
❑ Yes INo
❑ Yes ®No
Structure 6
1/6/99 Continued on back

acilityNumbec �1,—, 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
C9 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?
11,0 Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
P No
9.
Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
i9No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
®No
11.
Is there evidence of over application? ❑ Pending ❑ Nitroccn
El Yes
P No
12.
Crop type ....................... 1.14w`VLl.ft............ ,?.W..1A.�S...RJ9:ik.................. ............ .......................................................... ............................................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes M No
14.
Does the facility lack wettable acreage for land application'? (footprint)
❑ Yes
Ug No
15.
Does the receiving crop need improvement?
(Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
®No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
_ ❑ Yes[
No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
[P No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
M No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
/�
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
MO.. V1 ..�t.io. o..... e.....were noted during 3tiis visit:. You will.receive nb further . .
• atirrespbrideitce: abbitt: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):: --- - -
i. Coosa o fews ors :r..�r Ot4 0041 qF � n sho 6e F (lt � ycu
1"VVVe �iu;.y,t� �J✓p�wbLy Wig` rset t� �Q Uw ,
lC'_1etr, Lvgll-4. p
ly 4 o:A kf_& - For 'qY `F tqq S1.ovlr ate it tgrh 1 cwrt�J.
Reviewer/Inspector Name
Reviewer/InspectorSignature: ��� ,�,� �^ fJ�� Date: VJ0Ili 11/6/99

Q Dtvtston of Soil and Water Conservation Q Other Agency�g
5 �Divtston of Water Quality F„
..- ._ .
Routine OComplaint 0 Follow-u of DW ins ection O Follow-up of DSWC review 0 Other
Date of Inspection `l
Facility Number
Time of Inspection []� 24 hr. (hh:mm)
Registered E3 Certified gApplied for Permit O Permitted 10 Not Operational I Date Last Operated
Farm Name:...G.Q....�_� County:.......... 1�.................................. .......................
y.................................................... 1 4^.
OwnerName: ......... ' ...... .............................................................. Phone No:..... 1G.. a�f?._`.'. .......................
Facility Contact:
Title:
Mailing Address:...dV..l 1 1�C'a� �t�� V��\e...................../.......................................I.................................
Onsite�....................................
Certified Operator: ..................................................
Location of Farm:
Latitude 0' =' = °' Longitude 0' =' ="
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
allo
2. Is any discharge observed from any part of the operation?
❑ Yes
Z No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
M No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
IR 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
P9 No
3. Is there evidence of past discharge from any pan of the operation?
❑ Yes
XNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
EgNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
2q No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
k No
7/25/97

Faz+lityNpynber:3 —�c`
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
N No
Structures (Lagoons,Ilolding Ponds. Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
D( No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: 1 `D,
................................................................................................................................................................................
...................................
Freeboard(ft):......... 3 a :............................ I..:9............................................... .................................... ....................................
....................................
10.
Is seepage observed from any of the structures?
❑ Yes
[3No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
MNo
12.
Do any of the structures need maintenance/improvement?
Oyes
❑ 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
allo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
0 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type . ...... 2 .�t_...5!.................. .............................................................. ................................................. ..................................................................
.
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
L1 No
18.
Does the receiving crop need improvement?
® Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
IgNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
j4 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
❑ Yes
KNo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
Ef No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
6 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
M No
..........................................................
correspQndeitce.aboutthis:visit:::.:.:.::::.::.:
/tke�
4gl �h� �ti2 \gyp l c� e "\ ar- Q�iW� e Cyr l �-
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: '.� 11_�L—Ik , Date:

Facility Number ?,Sot
Follow-on of DSWC review
Date of Inspection
Time of Inspection
Use 24 hr. time
Farm Status: eT-,
(7' E D
Total Time (in hours) Spent onRetiiew
or Inspection (includes travel and processing)
Farm Name: T�1f.
CA ZT�f_,ez J'q 5'7 County:.t��—__—....� _...__...�
Owner Name:.____
= L £
.—
Mailing Address: %��T
� VC Z`'
�Phone�No:.$CL��—�_—
i�Se�tt/- �•• �_�
Onsite Representative: �T�.R._._
Integrator:.
Certified Operator: ��r4?
C,,:t4
Operator Certification Number: __.______
Location of Farm:
165
Latitude 0•=, 0" Longitude =• =' ='f
❑ Not Operational Date Last Operated:
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 5 Nn
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
a. If discharge is observed, was the conveyance man -[Wade? ❑ Yes 5UNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes UkNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes [No
i. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require es ❑ No
rnaintenance/improvemen t?
Continued on hark
Latitude 0•=, 0" Longitude =• =' ='f
❑ Not Operational Date Last Operated:
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 5 Nn
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
a. If discharge is observed, was the conveyance man -[Wade? ❑ Yes 5UNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes UkNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes [No
i. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require es ❑ No
rnaintenance/improvemen t?
Continued on hark

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/l/97)?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons and/or Holding Pondsl
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3
Z 3
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/irnprovement?
(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 strictures lack adquate markers to identify start and stop pumping levels?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or nmoff entering waters of the State, notify DWQ)
15. Crop type U
16. Do the active crops differ with those designated in the Animal Waste Management PIan?
17. Does the facility have a lack of adequate acreage for land application?.
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Oniv
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal. Waste Management Plan in any way?
22. Does record keeping need improvement?
23_ Does facility require a follow-up visit by same agency?
24. Did Reviewer/Iaspector fail to discuss review/mspecdon with owner or operator in charge?
❑ Yes
Z No
❑ Yes
®No
❑ Yes
®No
❑ Yes
❑ No
Lagoon 4
❑ Yes
Z No
❑ Yes
R'No
❑ Yes
® No
® Yes
❑ No
❑ Yes
aNO
a �
❑ Yes
fa No
Y
❑ Yes
0 No
s
❑ Yes
JD No
❑ Yes
VNo
❑ Yes Ea No
❑ Yes tp No
❑ Yes OlNo
[� Yes © No
❑ Yes No
r 0141
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-��
Reviewer/Inspector Name-
Reviwer/Inspector Signature: :✓
--
Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96

Site Requires Immediate Attention:
FaciliryNo.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE.. - Z 2 1996
Time: —o yS -A
Farm Name/Owns
Mailing Address:
County:
Integator, - % u gg i
Phone:
On Site Representative: Phone: 79Sr
Physical Address/Location: 1 1 �,��t�x•4s ScJ „ ( le�/I�t,�l(Q
Type of Operation: Swine ?� Poultry Cattle
Design Capacity: 1 <dG.0 Number of Animals on Site:
DEM Certification Number: ACE DEVI Cerdficadon Number. ACNEW
Latitude:_''" Longitude: Elevation: Fee:
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)6rzAr No Acual Freeboard: 2 Ft. Inches
Was any seepage observed from the lagoon(s)? 'Yes o I�o Was any erosion observed? Yesor
Is adequate land available for spray? or No Is the cover crop adequate' or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(170 or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ordo'
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(9
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No 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
1416
cc: Facility Assessment Unit
Use A[rchments if Needed. .
� vr.�
A(,or�rl� �J+vil�l� 7-0 "WE'a uNl_. GAG k 3pnJIL.

Site Requires Immediate Attention:
Facility No.'3/•
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -7 - 2, EL , 1995
T:...e. %.' ! e/q
•
•
Farm Name/Owner
Mailing Address:
County: t? t t tt + t
Integrator- Phone: 0110 -zG R— A-► 94
On Site Representative: <, � t--) O yg,�- r--, r r-, ig Phone: 19
Physical Address/Location: _::�Z ICJ & %
Type of Operation: Swine Poultry _ Cattle
Design Capacity: '2 S�1 Number of Animals on Site: -2 PRO
DEM Certification Number; ACE
Latitude: Longitude:
DEM Certification Number: ACNEW
AJOl�7�5 , ��jQIL( Q� Circle Yes or No
Elevation: Feet
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 0or No Actual Freeboard: G Ft. C) Inches
Was any seepageobservedTfrom the lagoon(s)? Yes of Io Was any erosion observed? e or No
Is adequa Aanr spray? (e -or No Is the cover crop adequate? Yes or
Crop(s) being utilized: Cry r) c t t-�o A
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es or No
100'Feet from Wells? (nor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or®o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No ± If Yes, Please Explain. CSC -
Does the facility maintain adequate waste management records (volumes of m e, and applied, S
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
T r) IZ-7 t7C1C l & 3nn
—
"t1fi- Lt��s tl r �—,f7 IL�� 1'tT t7`r S T/iT�s
1 �Y AT t T l� `s Lti
©T t CD t-i r c-tt 5 c-> t 1 t S C, v T° rt- H Cxa-!c
kl�) _If,rt'1 S H I\ts,t_
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

r
n
0
rl
or
r�

Facility -IN
;/ AP, Phone: _ 9'/0
Phone:
Phone:
f' 15 /a l
Mailing Address:
Type of Operation: Swine, Poultry Cattle
Design Capacity: ;�oL�Ou Number of Animals on Site: —
Latitude: o ngitude: o
Type of Inspection: Ground ; Aerial
• Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of i Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: z Feet .6 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 < g)Was there erosion of the dam?: Yes
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
•
1 6 LU k717) , •j-»Jy atgnature or Agent
A, ``

Owner. -'Jo i+ r sag' ''Farm Name:'
Coanty.
Agent Visiting Site: IJAL
Operator.
On Site Representative:
Physical Address:
Mailing Address: ' . •
Phone: '0 9/d e
Phone:
Phone:
Type of Operation: Swine Poultry _ Cattle
Design Capacity: Number of Animals on Site: 5r£r-6
Latitude: n ongitude 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 1 Foot + 7 inches) Yes or No Actual Freeboard: 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
CJ
Fax to [phone]
5

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATI N SITE VISITATION RECORD
• DATE: 1995
/j Time: 2 "
Farm Name/Owner: F-�� l_N'<i -Y�7
Mailing Address: oel Lc_— J8 S)g
County: PGI L /
Integrator. 1)IVAD t /?CYIj✓�2 Phone: d
On Site Representative: 4�U, 17 &'9 Phone:
Physical Address/Location: /
OAJ id
Type of Operation: Swine Poultry _ Cattle
Design Capacity:^ %DAD Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 V'' �1,� ' Long rode:'j 11'2
7-7 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have fficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche Yes r No Accrual Freeboard^�Ft. 6 Inches
• Was any seepage observed from the lagoon(s)? Yes of No'/Was any erosion observed? Yes r No
Is adequate land available for pray? Ye r No Isthecover crop adequate? es r No
Crop(s) being utilized:Ql�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings es No
100 Feet from Wells,*
ells es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of e state by man-made ditch, flushing system, or other
similar man-made devices? Ye or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
cc: Facility Assessment Unit Use Attachments if Needed.