310276_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Quai

Type of Visit: 1P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical AssistancQ
Reason for Visit: Otoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1'L S I Arrival Time: Departure Time: County: Region:
Farm Name: �� n c,_ S hn U C?-- tL-,M, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: C Title: Phone:
Onsite Representative: �. JC i h 1Q j y i Q& Integrator:
Certified Operator: Certi cation Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
Layer
Design Current
Capacity Pop.
Cattle
Dairy Cow
Design
C*apacity
C►urrent
Pop.
Wean to Feeder
I
lNon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
C•_a aci P,o
Dry Cow
Farrow to Feeder
Farrow to Finish
n P,oult ,
ILayers
I
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
r
Page 1 of 3 E
❑ Yes F No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No ❑ NA ❑ NE
❑ Yes `r'' No
❑ Yes 1P No
❑ Yes P No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
21412015 Continued
'4_J4

FaciliNumber: '3 .4 - 2 b Date of Ins ection: 12- S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej[ 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):lei.
Observed Freeboard (in): q b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EpNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes q No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes Epo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
§9 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�0 No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
j] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
��TT
[—]-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 [3 NE
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ; ❑ Soil Analysis`s ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections ❑ Sludge Survey t i-% _
22. Did the facility fail to install and maintain a rain gauge? 3 ❑ Yes W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 521 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Dte of Inspection: Z►
24. Did the facility fail to calibrate waste application equipment as required by theepermit?2
❑ Yes
M No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
14No
❑ 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
I}No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
fj No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes P�(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
0 Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW? P?
❑ Yes EA No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #):"'Explain any YES. answers and/or any additional recommendations or an other comments.. "
Use drawings of facility to better-4641aun situations (use additional pages as necessary). " -
13 F; icy
Sa1S 20 6
Reviewer/Inspector Name: ---Yjf— YQ. W C
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ' 1 ID 7q L 7 3'1 I
Date: 5
21412015

(Type of Visit: Q Corn nee Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: D 4 �— County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address: i
Facility Contact: Title: Phone:
Region:
Onsite Representative: co "J Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La erI I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Feeder to Finish
Non -La er I
Design Current
D P+Dolt . Ca aci_ Pao
La ers
Dairy Calf
Dairy ai Heifer
Dry Cow
Non -Dairy
Beef Stocker
T T V73
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turke
Turkey Poults
10ther
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 .LJ 1"v ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes No ❑_NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: 3 - 'L 7 1 Date of Inspection: 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0-N-o'__0 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): T
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) %
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes / No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes []No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes CrNo ❑ 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 [3--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
D-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
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes Ko
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Ld 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 El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes �o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 3 - 2 Z Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the penni ? ❑ Yes ETNo . ❑ 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 ❑- IAA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
,__,,�
E3 o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[; " o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E;,Ko" ❑ 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
Q 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
L'J 1Yo [] 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
F-1 No. ❑ NA ❑ NE
Comments (refer to question #): Explain:any.YES'answers,andlor`any additional. -recommendations or any other comments.
Use drawings of facility`#o -better explain situation's (use 'additional -pages as necessary).
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
11 J
IQ�V k_A_//
Phone:? , 77 C1 ;r3,!
Date: 1 / Zy Ll b
21412015

Type of Visit: Q'Com ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: C) (SJ Arrival Time: Departure Time: ®p County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: S C 9-f�— Or,, L--n Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: j 7/ 7
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine @apacity
Pop.
Wet Poultry
Capacity
Pop.
C►attle Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish
p
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D F P,oultr,
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ff No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No [] NA ❑ NE
❑ Yes [ N ❑ NA ❑ NE
❑ Yes Fa'No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Faeili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ffNo ❑ 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: Z
Spillway?:
Designed Freeboard (in): S
Observed Freeboard (in): 2 :57 3
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 E rNo ❑ 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 t reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑40_ ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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
��o❑ NA
❑ NE
acres determination?
1
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo�00 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
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
To ❑ 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 l " Rainfall Inspectio;OPD
udge 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

FZili ty Number: jDate of Inspection: () r S
24. Didthe 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 C] No ❑ NSA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑,'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality 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 L'J No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes EjNo [DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain.any.YES answers and/or any additional recommendations or, any other comments.
Use drawinEs of facility to better explain situations (use additional panes as necessary):
r�/'M (I-
V,LOtJ 3- k jez2
Reviewer/inspector Name:
Reviewer/Inspector Signatuz
Page 3 of 3
Phone: 119 77 7,3 o y
Date:
21412015

Type of Visit: Wcompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: R Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: / /y Arrival Time: Departure Time: /a ' County: �4 Region:
Farm Name: ?,gp,4 SO4LAaF FARM Owner Email:
Owner Name: &:�a7'T .yacy—� Phone:
Mailing Address: L/14/ 5 S WC C 50 C!- L,' LAA I Ni AJC d S of
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator
Back-up Operator:
Location of Farm:
SCc,T'T N . GaowN CertiLl
fication Number:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dairy Cow
C►nrrent
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
.5 a O
D , P■oultr.
Layers
Design
Ca a�i_
C►urrent
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turke s
Turke Poults
r70ther
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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes D No - ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: 1Z- tp 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 ❑ o ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: - )_ - C�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Iq 5 �9 5
51 �3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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? 4
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement? ,T
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): ��(Zi S 6)
13. Soil Type(s): V6& -6M YfjL7Ot-U-S CSoLDs03_ecs
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9No ❑ NA ❑ NEB
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 facilitylack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP QChecklists QDesign7 ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I; No ❑ NA ❑ NE
Q Waste Application ❑ Weekly Freeboard ' Q Waste Analysis 0 Soil Analysis ❑ Waste Transfers Q Weather Code
❑ Rainfall ❑Stocking E] Crop Yield 0120 Minute Inspections 0 Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility, fail to install and maintain a rain gauge? ❑ Yes N 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 1 21412014 Continued

Wer: jDate of Inspection- 1 ) Iy
idtheility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Otter Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
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.
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)
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 No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[DNA ❑NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA' ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: 1 /teQ
Date:
21412014

Type of Visit: ,Q 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_ 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: T Region:
Farm Name: Pan mmw-_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative:Integrator:
Certified Operator: Certification Number: ]] C EII
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I INon-Layer I
EEI
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D P,oult ,
Layers
Ca aci
P,a
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
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 2No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes KNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

acili Number: - Date of inspection: 3
Waste Collection & Treatment .
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Vj No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes []No ❑ NA - ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
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
Q 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
V'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
7T 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
LZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
;6 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
VTNo
❑ 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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Pn No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ETNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
V' 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 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall 0 Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes jffNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZI No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

f)FajcifiNumber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes e No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes oNo ❑ 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZrNo ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes VT No ❑ NA ❑ NE
❑ Yes A No [DNA ❑ NE
❑ Yes ,1 No ❑ NA ❑ NE
❑ Yes Vj No ❑ NA ❑ NE
❑ Yes No
❑ Yes [p No
❑ Yes �TNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: j(j —y _ _ _ _ _ Date: 9;43_ )*3
Page 3 of 3 —� 21412011

J
Type of Visit: V Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: VRoutine 0 Complaint O Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: i'v Arrival Time: /S Departure Time: f County: L (,)1.( /�/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �Ca'TT Z 9-0 V-W
Certified Operator: S Co- T I4 _ Q Q-o WN
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certif ccaonfNumber: 1 ] .49
Certification Number:
Longitude:
fY
Finish
7FReder
Design Current
Design Current
Wet Poultry C►apacity Pop.
La er Dai Cow
Design Current
FeederF
Non-La er
Dai Calf
o Finish
'
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
D . P,ouIt Ca aci P,o P. Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I I
Turke s
Turkey Points
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �kNo ❑ NA ❑ NE
�]
❑ Yes ❑ No ❑ NA ❑ WE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes No
[] Yes XNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [DNA ❑ 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
J�j 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
t*No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
XNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
K No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 1[] Application Outside of Approved Area
12. Crop Type(s): C6Q.N WH CAT Z �(H) 576)
13. Soil Type(s): /YO
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.
Q WUP ❑ Checklists Q Design Q Maps [:]Lease Agreements
❑ Yes`�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA [3 NE
[] Yes
� No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
Q Waste Application 0 Weekly Freeboard ElWaste Analysis 0 Soil Analysis [:]Waste Trans ers
Q Rainfall [] Stocking Q Crop Yield Q 120 Minute Inspections El Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes kNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - (q Date of Inspection: /O a.
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 0 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 ANo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes`] No
77��
NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
0
❑ 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
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 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No
❑ Yes tANo
❑ Yes No
❑ Yes No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additionalrecommendations or any other comments.
ijse,,oraAings of facility,to better explain situations (use additional pa es as nee "sary
�f � jl�
Sl
Sri
(o]ILl �1
1.5 g
1,19
colri a
is
/.3
1Og1)1
0.95
/.a
S L.kgGC ExE p� G e t L ��Go>v S i 1 c� � I�
L
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -/ /0 '9 9c0 —4o-)�
Date: ) d h /ho
21412011

Type of Visit: R�mpliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: I j Arrival Time: Departure Time: County: Region:
Farm Name: Q��} S 0Kt~ F—F Owner Email:
Owner Name: �Cd TT l� aU WX/ Phone: 1
Mailing Address: L"! ('! -! ..J S� �� C
Physical Address:
Facility Contact:
Title:
Onsite Representative: Is (Z T
Certified Operator: 1SC0.2:T
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
1`4 149
Design Current Design Current Design Current
Swine Capacity Pap. Wet Poultry ` Capacity Pop. Cattle Capacity Pop.
Wean to Finish ILayer IDiry Cow
Wean to Feeder
I INon-Layer I i Calf
iry Heifer
Design Current Dry Cow
D_ , Penult , Ca a_ci. P,o Nan -Da'
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets I jBeef Brood Cow
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Turke s
Turkey Poults
Other �::_dm
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No [:]NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
Yes
$rNo
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Cdlection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19.5 19 - s
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I AI 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 j�j 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 �Wiind Drift ❑ Ap lication Outside of Approved Area
12. Crop Type(s) �� 5 L/1�rc�
13. Soil Type(s): Of-k" P AC TOLAAs C �c�c l�SG30ep f
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
9'`No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists 0 Design] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes A
No ❑ NA ❑ NE
Q Waste Application 0 Weekly Freeboard Q Waste Ayalysis ❑ Soil Analysis ❑yaste Transfers Q Weather Code
Q Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections 0 Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes tNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: ( - Date of Ins ection:
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 ❑ NA ❑ NE
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 ❑ 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? ❑ YesiNo
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [DNA ❑ NE
Comments (refer to question #f): 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).
�.
Cjq(AGQ 4r1W
c�..O"E 5`Aa-"� C X C +AFr (AA17)(_ e I �}
S `�
Reviewer/Inspector Name: �r/Yi VC), t- 6,
Reviewer/Inspector Signature:
-
Page 3 of 3
Phone: 17 10 -, 15 6 13a3
Date: /I LIL1111
21412011

Faciiit,�Nuutber. -?,I C
Type of Visit ACompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit �6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1 Departure Time: County: Cr1N Region:
Farm Name: _� Owner Email:
cr'
Owner Name: � T_T I`t x1�Ji2��1q Phone:a
9l-,QgS-yto3
MailingAddress: LI L05 S 14 C _C^' CgtN�L AP/AJ. / V e' Dt J —
Physical Address:
Facility Contact: Title:
Onsite RepresentativecSC�TT Q igzc: L
Certified Operator: xorT 4 - 9 fzQjWW
Back-up Operator:
Location of Farm:
Phone No:
Integrator:QZ30
Operator Certification Number: f
Back-up Certification Number:
Latitude: = = 4 Longitude: = ° = 6
Design Current ._
Swine Wet'P ali
Capacity `Population ry".
❑Wean to Finish Fn ❑ Layer
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish
Oa
- ❑ Farrow to Wean
'
DryP.oultry
i. ❑ Farrow to Feeder
ElLayers
❑ Farrow to Finish
❑ Non -La ers
El Gilts
❑ Boars
❑ Pullets
— o Turkeys
❑
Other -: : ❑ Turkey Poults
❑ Other ❑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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[:]No
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
12128104 Continued

Facility Number: — tp Date of Inspection ]O
Waste Collection & Treatment XNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes ElNA [INE
a. If yes, is waste level into the structural freeboard? ElYes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ] of
Spillway?: n
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ 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
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [--]Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) CCL N Nf T <39 2 E 2 C
13. Soil type(s) /�& A C-TOL-(,.S CCIL1 S5G CAL_C�
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 P No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes �)�'No
'No [I NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES aitswei-s._'Wor any`recommendationi or any other con menu.
Use drawings of facility to better explain situations.:.(use additional a es as nec_essa i3)
Reviewer/Inspector Name
S Phone: 9/0 4 9(o
Reviewer/Inspector Signature:
Page 2 of 3
L� Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �[ o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo El NA El NE
the appropriate box. ❑ WUP El Checklists Design 0 Maps El Other
//////
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers `❑ Xnual Certification
0 Rainfall ❑ Stocking El Crop Yield El 120 Minute Inspections 0 Monthly and V Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauger
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?
❑ Yes W No []NA ❑ N E
❑ Yes
o []NA
❑ NE
❑ Yeso
❑ NA
El NE
El Yeso
❑ NA
to
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes �to
o ElNA ElNE
ElYes ❑ NA ❑ NE
❑ Yes tj13o ❑ NA ❑ NE
❑ Yes JE1 No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings:
Uj.A. I a
pl/n 9 . a 9.1
f I Fc- SET 1/0 Swc SAMF E
'g1aA-r1 can/ V�f_A E [ At ac)l i
Page 3 of 3 12128104

FaCtll Nuiner` Divtston of Soil and WaterConservatlon
_ #her°Age y
Type of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: of E Arrival Time: Departure Time: County: U � Region:
PFarm Name: �A Sm� �l t M Owner Email:
Owner Name:
Mailing Address:
Phvsical Address:
Facility Contact: (� �) Title:
Onsite Representative: _ SCID-n— `l�lww/Y
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: c ❑ ` " Longitude: = ° ❑ "
Ze-si n
g
Current
AL
Desi n Currents N '
g Design Current
_ �.�"x11
., Swme ., Capacity,r_Popnlation
Wti-
et Po.u[try
.Capac'ity+Populations _Cattle Capacit} , P-,opuration`
❑ Wean to Finish
❑ Layer
` El Dairy Cow
.:.
❑ Wean to Feeder
:. ❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
-Y.
Dairy Heifer
Farrow to Wean
�"`
� `�`
❑ Dry Cow
D Poult �
•
Farrow to ee er
W ❑ Farrow to Finish
❑ Gilts
E El Boars
Other
❑ Other F_ 4n
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Beef Stocker
Beef Feeder
Beef Brood C
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 9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ YesOJ�o
❑ NA ❑ NE
12128104 Continued

Pacilfty Number: 1 —a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Suture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ 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 V No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes bkNo ❑ 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 No El El NE
maintenance or improvement?
Waste Application ��(
10. Are there any required buffers, setbacks, or compliance alternatives that need El lll� No [INA ❑ NE
maintenance/improvement? V �
]1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IV No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes *o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes )A No
❑ NA
❑ NE
Comm(q p y R y � >. ` ons or,a1:
ments refer to` uestion# : Ex lain an 'YES answers and/or an recommendah any"other cottirnents
Use drawings of facility to better explain situations. (use additional. pages as necessa _.
Cr'-jtue Qu-i f30r-iCf_- ec cc/ 0 1Xv6 P C01t-' Pc.AIAvTT - Gr-b WLA-P 717?)aid
L4.3 1? - Toc-1-r. 1S 56ME VC.6" 7-)-,- / (c<MIWA4 G x/
'A S AAUCtq V C6C7AT)OW QQ rH
A/p eutpG- 6 F v-Ns76
Reviewer/Inspector Name F_M 4 l X I Al" 1c5 Phone: q%0 6
Reviewer/Inspector Signature:
Date:
12128104 Continued

Facility Number: -31 —.9W Date of Inspection 7 Ca
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
JJJJ� NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis El 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
❑ No
❑ NA
V NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
*E
24.
Did the facility fail to calibrate waste application equipment as required by the -permit?
ElYes
❑ 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
b�NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
El Yes No
❑NA El NE
❑ Yes No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes ).No
❑ NA ❑ NE
IAdditional Comments.aadlor Dra►vmgs ;w"��"
d 3
�.[�.—s�Sns ..
12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit XRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / QF'! Arrival Time: �� Departure Time: County: Al Region:
Farm Name: C�App �m�(L� �A( Owner Email:
Owner Name: SC�STT Phone: 91(!)_ DE S~ KOS�
Mailing Address: `M9 5S NC-c5,j3 C___¢i / /Gr2 Ai9p 1/ , / YC
Physical Address:
Facility Contact: Title:
Onsite Representative: S CO TT
Certified Operator: S C-077 (L�G7ot�X/
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 1 -4 I - `
Back-up Certification Number:
Location of Farm: Latitude: = o = , = Longitude: 0 ° =1 = 41
Design Current
Design Current
rent
Design CurIA
Swine CTo —ac it -VA Population
Wet Poultry
Capacity Population
C*attle Capacity Population
❑ Wean to Finish
ID Layer
❑ Daia Cow
❑ Wean to Feeder
10 Non -Layer I
I
❑ Dairy Calf
Feeder to Finish 1 57�
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
[INon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
Elullets ers
El Beef Feeder
❑ Boars
Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
No
El NA
El NE
Cl Yes
No
❑ NA
❑ NE
❑ Yes
kNo
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 31 —,gj6j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
.N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Struc�tre 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: !oc]
Spillway?.
�p Q
Designed Freeboard (in): (, 5 / . S
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
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?
19
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
KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
A No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No ❑ NA [INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
nA
)N No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) L 6W 11 86 T �� 15 CEZ01
)
13.
Soil type(s) �, Nmr-GLx PAC -To (_ t s (2-VL
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Fj No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
A No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments:(refer to queshon'a'#) >;platn any YE5:`answers and/ r any recommend atlons or anyRotlier comments. ,
Use drawings of facility to better, explain situations: (use additional pages. as necessary):
Reviewer/InspectorName Phone: °jjQ--4r 6-1304
Reviewer/Inspector Signature: Date: 9&3/105
12,Q8/04 Continued

M
Facility Number: —3) — Date of Inspection 10
Reguuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
IP No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
14 No
❑ NA ❑ NE
the appropriate box. ❑ W-Up ❑ Checklists ❑ Design 3 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
ElNA [INE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 3 Soil Analysis El �ste Transfers
❑�inual Certification
0 Rainfall ED Stocking El Crop Yield 0 120 Minute Inspections El Monthly and 1"
Rain Inspections []
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
[:3NE
If yes, contact a regional Air Quality representative immediately
`
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
*No
❑ NA
❑ NE
Additional Comments "and/or -Drawings ck
w•A-
I2128104

ja Division of Water Quality
Facility Number M
2—M
O'Division of Soil and Water Conservation
3
ClOther Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ?§ Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I is 8 68 Arrival Time: ® Departure Time: County: ����N Region:
Farm Name: ,, _
Owner Name:Sw-lr r (� ►--��?W !J
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative. 5 cap T U2aWN
Certified Operator: Sr —OTT H. Pj e ow N
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [� ` Longitude: 0 ° = r = "
Design Current Design Current Design Current"
Swine 7 'Capacity Population Wet Poultry ' Capacity Population Cattle T" Capacity Population
❑ Wean to Finish JEI Layer
❑ Wean to Feeder 10Non-Layer b
. -- - — - -
Feeder to Finish $O
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
I
t__:::�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: ..�a
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 4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
4No
❑ NA
❑ NE
12128104 Continued

Facility Number: 11-41TI&I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate?
❑ Yes
ONo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
0 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �• �. 5
Observed Freeboard (in): y y y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ 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 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDIiUdOn
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Wo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )§,No
❑ NA
❑ NE
l5. 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
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes 1.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
El NE
.Comments (refer to question #): Explain any YES answers and/or any recommendations or -any other comments
Uw drawings of facility to better explain situations. (use additional pages'as necessary)-
Reviewer/Inspector Name M 4 N Qo4 fqlW Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ 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 ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Cade
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
KNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
WNo
❑ 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
[P No
❑ NA
[:IN E
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? [:]Yes �RNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 14 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ZNo ❑ 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 VNo ❑ 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 A 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 ANo ❑ NA ❑ NE
Page 3 of 3 12128104

Facility Number
Division of Water Quality
O Division of Soil and Water Conservation
Q Other Agency
Type of Visit &CO pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time, County: 1�1�L� /�/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: <ccrr gebu^ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
W
Swine C:
'710 Wean to Fintsh
=;I❑ Wean to Feeder
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
LU Boars I
Other
. ❑ Other
Operator Certification Nnmber:
Back-up Certification Number:
Latitude: o ❑ ❑ Longitude: ❑ ° ❑ ❑ u
esignq Current' 'Design Current. ' l
ipacity Population Wet: Poultry . ' Capacity- Population' Cattle C
--I!
9JU Non -Layer I I U Dairy Calf
❑ Dairy Heifer
Dry Poultry.: ❑ D Cow
Yn AT,..,
❑ Layers
I
❑ Non -Layers
h
❑ Pullets
r
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of Structures ;ant
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
❑Yes
❑N
El Yes
L�1 No
El
❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 — Date of Inspection
Waste Collection & Treatment
--
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E❑ NA
4
❑ 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: LP 6-A /! LA Go V^j f Z
Spillway?:
Designed Freeboard (in): 1 q. S _ OIS
Observed Freeboard (in): L1ti 3q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes hd 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 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 th at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application �
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes C No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or lO 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) CWS r3 C N) S 6 o
13. Soil type(s) 66+-r L K 1577A (-To Log �U c.0s 6 o"
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
0No El NA ❑NE
2'N'o ❑ NA ❑ NE
�No ❑ NA ❑ NE
ENo ❑ NA ❑ NE
E No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/ur:any recommeodations.dr`�anyother comments.
Use drawings of facility to better explain situations. (use additional pages as necessary).:
•
Reviewer/Inspector Name L:_I ( Phone: 9% - 3$0
Reviewer/Inspector Signature: Date: % a 2 7 `fib
—5. c vJ a.vrsssrx"t:"

Facility Number: Date of Inspection FZW5710
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VN El NA El NE
lid N
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design El Maps ❑Other
/No❑
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
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
o ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Zo ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L'J No El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
L�"No ❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
ONo
❑ 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
C! No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
Cl Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

a.-)e
Type of Visit Fcompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /1 Arrival Time: Departure Time: County: iLL) � Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: {� Title:
Onsite Representative: 5c p it 3 o o W r�.j
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = . = « Longitude: = ° = , 0
Design Current
Design Current
Design Current
Swine
Capacc$ty
Population^
Wet Po: ultry Capacity Popu_ lation
Cattle .. fir_., ,Capac�xty Population
❑ an to Finish
❑ La er
❑ Daia Cow
❑ an to Feeder
❑Non -La et
❑ Dairy Calf
® Feeder to Finish
S'?-961
ElDai Heifei
El Farrow to Wean
10.
Ponitr?
El Dry Cow
ElFarrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Turkey Poults
Number o€ Structures:
❑ Other
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RrNo
❑ 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 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
PNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L Z
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 31 —i� Date of Inspection
*Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes L'I No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
StrucStructure 2, Structure 3 Structure 4
r
'U
Structure 5 Structure 6
Identifier: (A l LA C-.-.
Spillway?:
Designed Freeboard (in): [ c �~ �``� S_
Observed Freeboard (in): 377 Io
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes N El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
;No
6. Are there structures on -site which are not properly addressed and/or managed
[I Yes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
..thr�e , 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? ElNo Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo
NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > t0% or t0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) (t o,rs mv" Jn� Ltd ) ( C o
13. Soil type(s) N s Yt,F6 1 C G a L'W ej 6 tt-O 6( r 1i LL) S ,.,�
14. Do the receiving crops differ from those designated in the CAWMP? ElLfYes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:] Yes E IVo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes � No ❑ NA ElNE
18. Is there a tack of properly operating waste application equipment? ❑ Yes l_�`No ❑ NA ❑ NE
Comments (refer to tluestwFiaplam�any YES answers and/or any recommendations or any other comments.
Ilse drawings of facility totbetter eaplam�kiiflons�(use additional pages as necessary):
I;.,.:
A N D KC L0D
Reviewer inspector Name J., 4t /1% Z-, Phone: `IIb 96 7a.G T
Reviewer/Inspector Signature: Date: G U
1212&04 Continua

Facili4 Number: 3 — Date of Inspection /L u
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
❑ Yes Ls No ❑ NA ❑ NE
❑ Yes D'No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
04o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections!! ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
D o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E34o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
EK
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes❑
7No
NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�,/
O❑ NA
El NE
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�Zo29. ❑ 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
P4o ❑ 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
Lam] No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
No ❑ NA
❑ NE
*" tional:Cotnments andlor Drawings
12128104

3 -
Type of Visit 95 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ I]enied Access
Facility Number Date of Visit: Time:
Not O erational Below Threshold
..,(
LLi
Permitted p Certified 0 Conditionally Certified 0 Registered Date Last Operated r Above Threshold:
Farm Name: l�{//Qi�,� County: l�Lz.J !iC/rl/ti`/
Owner Name:Phone No:
Mailing Address:
Facility Contact: Title: 111Phone No:
Onsite Representative: / integrator: 45
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0 K Longitude ' ' Du
L l Wean to Feeder
I JLJ Layer I 1
11 ILI Dairy
Feeder to Finish
I �51DO 10 Non -Layer I 1 11 JEJ Non -Dairy
❑ Other
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
I otal SSLW
Number of Lagoons E❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
Ilalding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges && Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
No
Waste Collection & Treatment
/
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XN 0
S cture 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: f Z
Structure 6
Freeboard (inches): '12 2-5
05103101
Continued

Facility Number: 12 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,�(J No
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 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 9No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Cl Yes PNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes /5No
11. Is there evidence of over application` ElExcessie�e Ponding � El ElHydrauc Overload � El Yes 7fNo
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
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
No
15.
Does the receiving crop need improvement?
❑ Yes
�No
16.
is there a lack of adequate waste application equipment?
❑ Yes
ONo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Y(No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP, design,
❑ Yes
VNo
(ie/ checklists, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
O'No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
[dNo
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?
❑ Yes
to
(ie/ discharge, freeboard problems, over application)
V(No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ZNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
5XNO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
// No
10
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comurentsa(refer to question# ExplaEn a y YESanswers and/or any recmmendattoos or any ©ther cotnments-
Use drawings of fafflity to better explain situatibns. (use liddittonal'pages as=necessary)
:. ��: �. Field Covv
i -.
❑ Final Notes
�t�r,�-,' �✓�2P�c.c_ J 2% F GS ��L ./��i�Ti4�i.1 �'Q'
�EC��Qi/Js
N Q/1 DC2.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: .�f//,7 //JZ
O5103101 Continued

Date of luspection Printed on: 7/21/2000
Facility Number: 3/ —2
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below
❑ Yes
No
y
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
0 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
YNO
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
IVrNo
5/00

Type of Visit ,'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit JQfRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Acoess
Date of Visit: 2$ O I Time:
FFacility Number 3 Z 7
O Not O erational Q Below Threshold
0 Permitted 0 Certified 13 Conditionally
� Certified [3 Registered Date Last Operated orAboveThreshold: ..................
Farm Name: pa, �0 G► Srnv,r 7 tit+ County: D vI 1.. `% .................._.
...................................................G....r.......... .....................•............................................................ .
OwnerName:.......... s. .`. ?.1....... .0 W.',............................................... I............... Phone No:.................................................................. » ... �.
FacilityContact: .............................................................................. Title:
PhoneNo: ..................................... . ........ . .
MailingAddress: ....................................................................................... .................................................... .........................
Onsite Representative: �Re ow e% Integrator: f ! Q s .........„ ........
-----------------------------•-•---.....................-----------------•......................................
Certified Operator: ................................................................................................ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° 46 Longitude • A 46
• Current Design _ _ ,Current sign Current
Swine PoulaciPoulton. C^PCa"aci Po elatioryCntatfott.:.
❑ Wean to Feeder I0 Layer ❑ Dairy
❑ Feeder to Finish I[] Non -Layer El Non -Dairy -
❑ Farrow to Wean _
Farrow to Feeder ❑Other
Farrow to Finish -TotaSl CB
Gilts .�
P
Boars Total SSLW
Number La goons 2—❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area r`
HISoldTraPsol Ponds , Lid Waste Management System `-:
Discharees; & 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 gaVmin?
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: ............. I.. �.............................. 1Z
11.1l........................................................................................................................
Freeboard (inches): Z T 1
5100
❑ Yes ZrNo
❑ Yes ;'No
❑ Yes )2fNo
hrc�
❑ Yes P'Ro
❑ Yes ONO
❑ Yes ONO
❑ Yes P'No
Structure 6
Continued on back

Facility Number: 3) — Z rf Date of Inspection 2 $ 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1p�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 ONO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ZNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes PfNo
9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ,2fNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding )Zj PAN ❑ Hydraulic Overload AYes ❑ No
12. Croptype �e+^rnJoiq �.�,,�efw.vdc, ta�^a+2.��•S••ae�tl G `�n, i-�srvP T'cs4v{e, CD�yt,Wl-&i4,feel
115
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO .
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,BNo
b) Does the facility need a wettable acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? [:]Yes gNo
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?
d�fcienre ho(ed. during this:visit; :Y:ott w,i11•tee¢iye Oti tut-tbtr
.•.•correspontYen�e.a�wu�this.visit.•.•.•.•.•.-.-.-.•:•:•:•;-.- - - -
❑ Yes WNo
❑ Yes ,e(No
❑ Yes �ONo
❑ Yes ONO
❑ Yes 9No
❑ Yes )dNo
❑ Yes XNo
❑ Yes Z'No
❑ Yes )'No
❑ Yes ONO
❑ Yes )dNo
Comments (refer to'question #} Explaut anijiy, YES answers andlor any recomnaemlatioas or any other comments. r
Use drawlpgs of fardlity to betterTexplain situations (useadditional pages as:necessary)
-T�e,re ,� 6vev',q ff � cff4�-n►, ar f lar►I vA; wie A11 •-�ro5�n on Ae "ZDO
Carr) crop oh Trlq !og 25 PU)1 Z 2 16s �aGre .
Its.T-he L✓e}jable Acre.S .de4,errn)'n44>dn 1.rs {bee' dahe Q►10( Mr.13rown-
sq�i - 1ai+41,;s ACveti)e W be vse1d ors4.e Sa2r2-il-i 4 Ze2-Zes
{Jr-'�i i h �t � ' `y vy j^�• � 'i.�e W iV�"Q'r GivO,fl ,� 1 � f .7 )��
19, Be 5 vee 4o use ei w-q r,.r4e A 1 r ''-r Q 14ea( tw,,44: , 60 a%VA)
4' ckppl: ccge'oh _
ev"4s o� Le =02-2,,.f_ rie�o ),AV - 1,e vo id XI.S1s Ccah4)
R
7,Z
a:
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ _ f _ _ _ Date: TB Q j 5/00

Facility Number: — 2717 Date of Inspection 2 D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ 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 10 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J6 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 m No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or I
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ,f No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 12 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additionalomments an or Dra-
wAJ4e so -Fhb 4)ie nvi r;cn� valve
i S hpW h l''I my n ►sloe
5/00

_ Q DiAA6n of sail and Water ConservatioII ''Operation Review- r' ' k ;� «
`g DivisioII of Soll nd'er:C Watonservation = m Copliance inspection a _ *
�•Divisiog of Water Quality :Compliance Inspection
sOOthersgency Operation Reviewer
A
F0 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 2 Date of Inspection
Time of Inspection .dU 24 hr. (hh:mm)
Permitted © Certified © Conditionally Certified © Registered 10 Not Operational ate Last Operated:
Farm Name: .. Count ....... �...z1..%./1............................................
L 7
Owner Name �C!' %Dfij/!� Phone No: ....11/:..:/...�,<.....
.............. ................................................. .... ...... .............. .............. ....
VI
Facility Contact:.....................�r�lli�.-..Title:................. .. Phone No:
................................................................................................
MailingAddress:....................................................................................................................
Onsite Representative:.S«Y4W>�
... ..................
........................................&.41",
Integrator:(�D!`......................................
....................
Certified Operator:..........Cv
QWI?
r ...........................
Operator Certification Number: ..........................................
Location of Farm:
L.........................................................................................................................................................................................................................................................................�
Latitude �� ��� Longitude
Desig
n- - urgent:_ : Desigp Current Design Current
Swine Capacity Poultry lationCattle _ .Capac--fd'lation,
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 2W Z ❑ Non -Layer I I Non -Dairy
❑ Farrow to Wean _
R- ❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish `-Total Design Capacity
❑ Gilts
❑ Boars ToW SSLW =
Number of Lagoons ?� Subsurface Drains Present ❑Lagoon Area Spray Field Area .;
Holding Ponds / Solid Traps ' ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (II' 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 kNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: m-1
Freeboard(inches): .........3..3....6 .................3`f ............... .............................."................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, []Yes � No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 I — - 7& Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN AID
12. Crop type
13, Do the receiving crops differ with those designateen the Certified AAal Waste Management Klan (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. 1s 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/lnspector 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?
•yi6Wi6iis:or de#ide.neies •v,�ere poted- during #his:visit: • Y:oit will-teceiye do; fui-tlzer • . • . -
correspondence. about this .visit.
Comments (refei_i question #): Explain any. YES ariswersCand/or any recommendations or"an"thts-
yoer eoQirnen
Use drawings of -facility - to_ better explain situations (use4dditional'.pages as necessary) " .y
�. Oe
h,, AIW f 7*e&
.. ._
V GA�'!l �T �9q
❑ Yes KNo
FCVes EVNo�
Yes �eNo
❑ Yes L No
❑ Yes DrNo
❑ Yes rYNo
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
OlYes ❑ No
[:]Yes VNo
❑ Yes ONO
❑ Yes No
4 Yes ❑ No
❑ Yes No
❑ Yes KNo
❑ Yes T'No
❑ Yes 4No
❑ Yes EN No
❑ Yes RNo
Reviewer/Inspector Name (.
Reviewer/Inspector Signature: /� Date:
3/23/99

Facility Number: — Date of Inspection
Qclor Is, sues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
s o
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
FVNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
V[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
9CNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
broken fan blade(s), inoperable
❑ Yes
or shutters, etc.)
-V�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?
ditiona � omuients an_ or rawings:
,Q
�5 /s �%Jf�/ S� �yi��U�/ 'pyyl/ �a44
J >�
q)
Q t, -rla
c �
.
3123/99

eview -0 Division of Soil and Water Conservation Qperati:on R_ ? ,
- [3 Division of Soil and: Water Conservation ':Compliance Iiispectio'n =
Division of Water tZuairty -_Compliance Inspe_ clian
_,.Lj:Other- Agency. ;Operation Review:=_
w
JID Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 I 2 Date of Inspection 2
Time of Inspection 345 24 hr. (hh:mm)
® Permitted © Certified © Conditionally Certified © Registered JE3 Not O erational Date Last Operated:
Farm Name: - ... ^.-.... SyV! V In -� F4 r'� County:.....................................................................................
Owner Name:.......0 d ..---•.-..r.......Y Phone No:
................................................
Facility Contact:........--.•.................................................................. Title: .
MailingAddress: .............................................................................................
Onsite Representative: t) ......`S.0...................................................................
Phone No: -.
......... .......... I .......... I................... .....r........................................-....................
Integrator:...` �.............1.l.............................................
Certified Operator: ................................................... ., .... Operator Certification Number:
.......................................................
Location of Farm:
r................................................................................. .............. ..............................................-------------- ....-................... .................. .......... ....... .............. ..................... ........ .........
� .
Latitude �' �� �•� Longitude
Design Current- - .
g Design . Current Design Current
Swine _ 'Capacity Po ulatioii Poult: 4
ty Y Y Capacity .. Population Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
5-2g(j
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
� Subsurface Drains Present ❑Lagoon Area S pray
Feld Area
Lagoons L .J P YNumber of
Holding>Ponds / Solid Traps I ❑ 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 roan -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: j QQ / -Z
Freeboard(inches): ......3+'J...................1..........36. .... .... ............................................................................. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 19 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ Yes No
Structure 6
............................
❑ Yes 0 No
Continued on back
3/23/99

Palility Number: 3( — 27 Dale of Inspection
6_ Are there structures on -site which'are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? []Excessive Ponding ❑ PAN
12. Crop type &e/, m v c1 f g c y / . -6
[:]Yes 0 No
X Yes ❑ No
❑ Yes ® No
❑ Yes 19 No
❑ Yes gNo
❑ Yes ® No
13. Do the receiving crops differ with thoseIdesignated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? [:]Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? CK Yes ❑ No
15_ Does the receiving crop need improvement?
16, Is there a lack of adequate waste application equipment?
Re uired 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?
0: N,6-, iMhtioris:ojr &fide.ncies - were noted• cling this,visiL • Yott Will •r,e &W iio #'urthlrr
co rres�oiidence. abuuf this .visit« . .
0 Yes ❑ No
❑ Yes g No
❑ Yes N No
❑ Yes 191 No
❑ Yes M No
❑ Yes No
❑ Yes j No
❑ Yes No
❑ Yes No
❑ Yes] No
❑ Yes No
Comments (refer t6cjuestion #).=Expfidn any YES answers-aud/or any` recommendations.or any other'comments ,
_
Use drawings of facility -to better explain situations:_{use additionalpages as necessary) -
7. Mpkv ijqsida,_ ore /Agoph t' fills• Gon4;,ve eAor4s 46 V2 je> A4e
aria a Sfq orI
14, �� 1�� if Fended to w-*&blQ
15. " new !y s1,,:99 e e( (,et�►�•t vda 1
Reviewer/Inspector Name
Reviewer/Inspector Signature: �, , Date: V 2
3/23/99

Faeility Number: 2 date of Inspection
Odor Iss"es
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
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
JAddifial Comments-and/or-Dfawings,- W _ --
ALI
3/23/99

Division of Soil and Water Conservation E3Other Agency
Division of Water Quality
19PRoutine O Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review O Other
Date of Inspection (Z
Facility Number 2� Time of Inspection tpo 24 hr. (hh:mm)
0 Registered VCertified 0 Applied for Permit Permitted E3 Not Operational Date Last Operated: ..........................
Farm Name: .................0.l9. �lrlufF:... Countv:......�v��.l..............................................................
S. \.......... ..................................................................... a o�� AFC
OwnerName:........_...........GA. i...................... 11tOLnIY�............................................... Phone No:..................................... 4C31 ......................................
FacilityContact: ............................................................... .............. Title:................................................................ Phone No:
Mailing Address:....... ."las....._�.:R .....NG..%%.try...$0............................................... IrN:ihp.1.atlin..l
... ]ML.............. ............. ....?..$Sl..l.........
Onsite Representative: .............. SC..arflxr`-.......................................................... Integrator: .......I.....eit rA (.S.
Certified Operator;............................................................................................................... Operator Certification Number ..........................................
Location of Farm:
Latitude =e =' =" Longitude =• =' ="
a " ` Current• _`� Desi Current . ` '` Desi Current = Desrgn gu
",-Swine ,, 4 Capacity; 1'opulatiod ; Poultry Capacity Population Cattle Capacity,"Populari"_ on
❑ Wean to Feeder' ❑ La eE��= 10 Dairy
Feeder to Finish 0 S LYO ❑ Non -Layer 110Non-Dairy
.'" ❑ Farrow to Wean
,� ❑ Farrow to Feeder -= ❑Other
❑ Farrow to Finish Total Destgn Capacity
❑ Gilts
❑ Boars Total SSLW=
Nu" of Lagoons /Holding Ponds -0.ja Subsurface Drains Present ❑ Lagoon Area lf&SpravField Area
k• : , ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated Flow in pilmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
IPNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
Ep No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
iAYes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
P No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
i No
7/25/97

Facility: Number: 31 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
1�No
Structures (Lagoons,11olding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
W No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: 7-
................................................................................................................................................................................
...................................
Freeboard(ft) ................:.r1........... ................ Ita.......... ........................... ... ..... ............
10. Is seepage observed from any of the structures?
❑ Yes
No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
❑ Yes
J3 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
RNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type �?":11•Jrr...........sx!'01...,c��zLtr-....................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
QNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
®ND
18. Does the receiving crop need improvement?
Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
( No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P No
22.
Does record keeping need improvement?
EP Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
EP Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
M Yes
❑ No
0• No:vioilatioin,or deficiencies rvere"ntited-iiuring this:visit. You:vviu receive•ito-furit e_i-:
. e0respdWeitce about this:visit:• :::
l�S. �tr��i,�c i r` tGv� (�rcas of ► cit)s l 4- iiz TZJ Si�Ov�f} be, rc$Qr;��e�
Iry �^�11F' 1�C�blf� GC.�i f�Dr SY►�O�l� 0�lb�S� SvUI 2K}E� rF0
S �-, — �r �1 • ��c�r.. d eS t r,S S�d �C.f �ee � � `� ��'�'`�` '�.g,+rv+�. U{-Gc�r) � . i �n,. u+'`os� � i rw i �l �]
NI� \ietirmvOo- AIAQJ r) We, V -t- \y, I- tL- Z � T- 72-2-P
t4.�rS, M��tir Od'c�a4A�'s��`6�^ 0 r►�ractct• ti q+Cwtin i� <Zs�b�/G�, 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

_..__._.__.......... m.....:..
0 DSWC Animal Feedlot Operation Review 9
F �a] DWQ Animal Feedlot Operation Site Inspection.
Routine O Contnlaint O Follow-up of D«'O inspection O Follow-un of DSWC review O Other
Facility Number 3 7,26
(3 Registered [3 Certified Applied for Permit © Permitted
Farm Name........... �0......... 5lAXl ......-
Owner Name:..........! �,, .....�axtbW31..................
Date of Inspection
Time of Inspection 24 hr. (hh:mm)
13 Not O erational Date Last Operated:
County:
Phone No: 7
c-.....................................�a�. z................................................
Facility Contact: ....... C .... ................................I... Title: ......... d(j1%&.�.................................... Phone No:..�
MailingAddress:.... .................&A............................................ ....�:�in�G�r�£Yt.�.....M................................. S� d.........
Onsite Representative: ....... cott--.11bkb-% ................................................................. Integrator: ........ a'i.1'Y.iiirS.... ............. .........................................
Certified Operator,............................................................................................................. Operator Certification \'timbert...../`7�,C 1rf.........- ..
Location of Farm.
,�T�......? ....SO...n4....tx?!:.:.Tllfin...........a...ix�......�R..47...:......r..►ta....:.s..a:^{....�!aeLes.....a�..................
....... ........... . .. .
........ad........................................................................................................................................................................................
Latitude ' i .4 Longitude ° 46
Design Current
Swine . Capacity Population
❑ Wean to Feeder
Feeder to Finish
-5'ao
Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 61-fV
Total SSLW ( y
Number of Lagoons 1 Holding Ponds Subsurface Drains Present ❑ Lagoon Area JJR Spray Field Area
❑ No Liquid Waste :Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes RNo
2. Is any discharge observed from any part of the operation? ❑ Yes allo
Dischar�,e originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [,9 No
b. If dischargc is observed, did it reach Surface; Water? (if yes, notify DWQ) ❑ Yes 19 No
c. If discharge is observed, what is the estimated flow in gal/min?
Al
1A,
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
ElYes
JZ No
4. Were there any adverse impacts to the waters of the State other than from a discharge'?
❑ Yes
allo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
CO No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
[I Yes
VNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
RNo
7/25/97 Continued on back

Facility Number: -3 1 — 27(,
8_ Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes QI No
Structures (Lal oons,Holdine Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes W No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.��................. ..........Z........._......
Freeboard (fty...........�.4.................. ....3 .................
10. Is seepage observed from any of the structures? ElYes [%No
I I- Is erosion, or any other threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...... CQQ�5.IJ........ Wnalvar,................. ............... ................................. ....... Carr ........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
® No violations or deficiencies. were noted during this.visit.- .You.will receive no further,
correspondence about this.visit: '
[]Yes 5 No
11 Yes ❑ No
❑ Yes [Z No
❑ Yes 56 No
❑ Yes Id No
❑ Yes RNo
❑ Yes [Z No
❑ Yes IFS No
❑ Yes Od No
❑ Yes P No
E? Yes ❑ No
❑ Yes IZNo
❑ Yes (@ No
❑ Yes ®No
Cor ►ments,(refer to question #): Explain any YES answers and/or any recommendations 'or any;lother comments j
Use drawings of facility to better explarnr situations (use additional pages as necessary}
IZ- o taa.Els c Sao �nc s,d� mow e�. EroS�an f
40� 1 -#� f Z sHotl�b be- '�! o
tvi{�. e. reseealed� re wreas 51u�1d reseejej-
-Z • K t �'Orrtc0 r� i b {�aJ�{� b ti r t't tM.r+ /rL*, ^uyn � er - &j C"YcrJ Fie [ � nu4e r,
i-a�on belrr� Po►n�Pt� sj l� (�� (a �� �r i�✓I an re0vis. 1-0-3o&N der,'T, t ilyi0wh "5
e,►�b �ta.c{fit �er�►�ck�^ sl��� ioe o� �� �
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: jt; A.— A-, - / j„ Date:

Site Requires Immediate Attention: v
Facility No
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANTMAL FEEDLOT OPERATIONS SITE VISITATION RECORD l rC27�D
DATE: 9 ` 6 . , 1995
L�
Time: _
Farm Name/Owner: 9 a, --
Mailing Address:
County: v—
Integrator: C�(-.k—ft ►'�,,� vt- S Phone:
On Site Representative: _� �� 61 �s� Phone:
Physical Address/Location: N C S CL 1.819,4—
.
Type of Operation: Swine, Poultry Cattle
Design Capacity: CMS 0 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 4`9 ' 4-1 " Longitude: :1 Z' C 19 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagogrt hav icient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes o No Actual Freeboard: 3 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available.for spray? Yes or No Is the cover crop adequate? Yes r No
Crop(s) being utilized: _ e u rt CO+>,S►
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (EDDr No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o nNo
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 of l If Yes, Please Explain -
Does tl e facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o(o�
Additional Comments: ��
Inspector Name
5
Signature
cc. Facility Assessment Unit
Use Attachments if Needed.

i
Site Requires Immediate Attend
Facility No. n r f
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995 NC-,-
Time: 0 -2 84 f — Li (:,3'7
Faun Narne/Owner: PW Y Yv► C,_r F' s ��'Y"nA— (Y1124 h i o tj a ory r/N 1 5r
Mailing Address: T4/f-fi- y C .) Sot;. .. Ctil N9u�zA� .'�t1� AIC .'l�'._ZI
County: - hij
Integrator: CA Y Yt) 1 J i�a Phone:
On Site Representative: 41 6i _ � ��r _ Phone:
Physical Address/l
Type of Operation.
Design. Capacity: do Number of Animals on Site:
DEM Certification Number: ACE DEM Certification -Number: ACNEW
Latitude:---��_" Longitude:_ Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: —7—Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or� Was any erosion observed? Yes oz 1V
Is adequate land available for spray? Oe' or No Is the cover crop adequate? G or No
Crop(s) being utilized: 9
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? a or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or&
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(9 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)? nor No
Additional Comments:
o.
Inspector Name - Signature
cc: Facility Assessment Unit Use Attachments if Needed.

F�>
OPERATIONS BRANCH - WQ Fax:[phone] Aug 1 ' 95 11:34 P. 06/20
0
•
Site Requires immediate Attention
Facility Number: 31 - 11
SITE VISITATION RECORD
- DATE: 1995
Owner: Farm Name:
County:
Agent Visiting Site: ovf fa., -- . ._ Phone: -Rid.
Operator: Phone:
On Site Representative: _ __ Phone: _ ]
Physical Address: On 9L 1Ejq 446wilt,i 1
Mailing Address:
Type of Operation: Swine Poultry Cattle
Design Capacity: _ Z 5 9r) Number of Animals on Site:
Latitude: o Longitude:___2 I"
Type of Inspection: Ground Aerial ,
Circle Yes or No
Does the Animal Waste Lagoon have suf£eient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I. Foot + 7 inches) Yes or No Actual Freeboard: __.L_ Feet ,L Inches
For facilities with more than one lagoon, please address the other Iflgoons' 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 adgnate land available for land application? Yes or No Is the cover crop adequate? Yes or No
,Additional Comments:
t
Fax to [phone]
Signature of Agent