310284_INSPECTIONS_20171231

"7WSA
1 11 2
NORTH CAROLINA
Department of Environmental Quality

i�ision of Water Resources
acillty Num Division of Soil and Water Conservation
OQ ©ther Agency
Type of Visit: JOTCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 04outine O Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: /fi Arrival Time: ` Departure Time: l D County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title: Phone:
Onsite Representative: of Integrator:
Certified Operator: Certification Number: 7 3 ko
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pup. Wet Poultry Capacity Pop. C*able Capacity Pop.
Wean to Finish Layer Dairy Cow
can to Feeder h oq .z 4 v_0 Non-La er I Da' y Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current D Cow
Farrow to Feeder D P,oult�, Ca aci P,o Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers I Beef Feeder
Boars Pullets Beef Brood Cow
keys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes o ❑ 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 DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) [] Yes ❑ No ❑ NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes bNo .❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection: [o
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 2
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ffZ ❑ 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 PNo ❑ 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 Ej"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 0 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?
I t. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes Io ❑ 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 [3'�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�Xo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes []NNo ElNA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑'N/o ❑ NA ❑ NE
Re uired Records&Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes [/]No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑Maps ❑ Lease Agreements ❑Other.
21.Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes []No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1"Rainfall Inspections ❑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 gNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: Date of Inspection: '� /
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:] Yes �6 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check es '❑ 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 Q-N'A- ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
30.Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31. Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes ❑'No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ETNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes f f No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes EjNo ❑ NA ❑ NE
Comments(refer to question ft Explain any YES answers and/or any additional recommendations or any other commeli&-
Use drawings of facility to better explain situations(use additional pages as necessary).
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Reviewer/Inspector Name: 1 I k V�C ..� { Phone:
Reviewer/Inspector Signature: ----�� Date: T4 7
Page 3 of 3 21412015

I)i'vi`sion of Water Resources
Faciitity Number t?J---- - Z Division of Sail and Water Conservation
�Other Agency
Type of Visit: Com ' ce Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 'Z F Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: O �� C f( Integrator:
Certified Operator: Certification Number: 173 a"9
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design C►urrent Design Current
Swine C►►opacity Pop. Wet Poultry Capacity Pop. Cattle C•apacih Pop.
W to Finish Layer Dairy Cow
Wean toFeeder -LPo Non-La er I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Ca aci_ P,o Non-Dairy
Farrow to Finish I Layers Beef Stocker
Gilts Non-La ers Beef Feeder
Boars Pullets Beef Brood Cow
Turkeys
Qther Turke Pouets
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:] Yes Fe, ❑ 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 DWR) [:] Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [?TNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [!j'No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection: n 6
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes [a-Mo— ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): �22
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 L2 Ko ❑ 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 Efy 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 rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks,or compliance alternatives that need ❑ Yes C2 5o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes P ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN • ❑ PAN> 10%or i0 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 L No D NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [�No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes FZeNo ❑ NA ❑ NE
Required Records&Documents
19. Did the facility fail to have the Certificate of Coverage& Permit readily available? ❑ Yes ff No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes,check ❑ Yes No ❑ NA D 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 dNo ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and I" Rainfall Inspections ❑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? ❑ Yesg�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 1 Date of Inspection: t 0 OLZfj
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check [—] Yes No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑' Iqo ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes ❑ No 0- —A ❑ 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 - Flo ❑ 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 ONo ❑ 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 G3-fq—o ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes Now❑ 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 recommea_dations,or any other comments., M .
Use drawings of facility to better explain situations(use additional: a es as necessary).p g
t`0.
.�
Gam...� 1..►�c. l� 0 � e. {.s �.o n S �C v• (v
770
Reviewer/Inspector Name: Oey✓ 1 C ( `� "� �I Phone: �9 _7q 6
Reviewer/Inspector Signature: (/ Date: 0 Z I
Page 3 of 3 21412014

1z
Division of Water Resaurces
Facility Number ❑ - Division of Soil and Water Conservation
�O#her Agency
Type of Visit: Co7liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:�0 Departure Time: County:DL)jjg-WRegion:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ch P=< Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design C+urrent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish I JLayer Dairy Cow
Wean to Feeder I JNon-Layer I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder D. P,oW Ca aci_ $o . Non-Da'EX I
Farrow to Finish La ers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
Turke s
Other Turkey Poults
Other 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes V�io
NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: Date of Ins ection:
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes No ❑ NA ONE
a. If yes,is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L.A&a>1J
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IdNo ❑ 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 2�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 or2Yes
ronmental threat,notify DWR
7. Do any of the structures need maintenance or improvement? ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:] Yes F2/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. [7/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers, setbacks,or compliance alternatives that need ❑ Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
11.Is there evidence of incorrect land application?If yes,check the appropriate box below, [—] Yes 2No ❑ 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 o ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable El Yes No ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes �No ❑ NA NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes go ❑ 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 YNo ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1" Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

• Facility Number: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �40 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes E�No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance:
26.Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes �xo ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes hfo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 0/Xo ❑ 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 EjXo ❑ 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 ❑alb o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ffNo ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes � o ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments(refer to question ft Explain any YES answers and/or,any additional-recommendations or any other comments. ,
Use.drawings of facility to better explain situations(use additional pages as necessary).
uE C l3 TO A ov9_C_- SS DZGG�Lu G-—l-�J L.A &196t' IVAL-L
Reviewer/Inspector Name: do, �J 4 PW LUL- __ _ Phone: ulo ' fD
Reviewer/Inspector Signature: Date:'/ .-y is-
Page 3 of 3 214110,14

f
ivi'sion of Water Quality
Facility Number - 00 Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 21ioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j Arrival Time: Q Departure Time: County: � Region:
Farm Name: s " _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:, Integrator:
Certified Operator: Certification Number: 3 moo/
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design ]EN
Design Curren1!Swine Capacity Pop. Paultr.y Capacity Pop.Wean to Finish r Dai Cow
Wean to Feeder La er DairyCalf
Feeder to Finish DairyHeifer
Farrow to Wean Design Current D Cow
Farrow to Feeder Dr. P,oult. Ca aci Ito Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Beef Brood Cow
keys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes . �frNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes jfrNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑ Yes E2-No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes j 2,f4o ❑ NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes EJ No ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 6�No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of-inspection: 7 /
Wastc :olleciio_n&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes,is waste level into the structural freeboard? ❑ Yes Z No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): pZ [J
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [� o ❑ 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 2�`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 ONo ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks) T
9.Does any part of the waste management system other than the waste structures require ❑ Yes gNo ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication '
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ff No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground D Heavy Metals(Cu,Zn,etc.)
M 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 A,No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes ,dNo ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ZNo ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes 10 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes P�No ❑ NA ❑ NE
ReDuired 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 ff 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 nj'No ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1"Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? [:] Yes No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24. Didpae facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes �;Ko ❑ NA ❑ NE
the appropriate box(es)below. T
❑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 .fNo ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E3'1Go ❑ 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 ;2-lqo ❑ 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 O/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 P�No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: T
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes oNo ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ZNo ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? (—] Yes ❑allo ❑ NA ❑ NE
Comments(refer..to question ft Explain any YES answers and/or any additional recommendations or any,other comments..n,
Use'drawings of facility to better explain situations(use additional pages as necessary).
V1103 1 3
U � i��12
Reviewertinspector Name: Phone: q
Reviewer/Inspector Signature: Date:
Page 3 of 3 2141 011

k
,..
A),V ISIOn of Water Quality
Raeilt Number �.g 04Drvision of Soil and.Water Gonservation
r.
x Q.Other A gency
l z
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral .O Emergency O Other ❑ Denied Access
Date of Visit: -- Arrival Time:I
Z_ '., G' eparture Time: County: CL Region: r�r
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: r�S rf' r Integrator:
Certified Operator: Operator Certification Number:
173� ��
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =° Longitude: °
Design Current's Design Cu�rreot D sign Current ,
Swtne' Capacity, Population Wet Ponitry ;Capacity PopulattonN Cattle pacity�Papulat"on
=
`❑Wean to Finish ❑ La er I❑Dairy Cow
❑Wean to Feeder ;❑Non-Layer El Dairy Calf
❑Fee
der to Finish - r ,❑Dairy Heifer
El Farrow to Wean ❑D Cow
El Farrow to Feeder,Dry Poultry
❑Non-Dairy
;."❑Farrow to Finish ❑ Layers
El Beef Stocker
❑Non-Layers
*❑Gilts ❑Beef Feeder
❑Boars ❑ Pullets
s❑ ❑Beef Brood Co
Turkeys
Other: Turkey Poults
El Other ❑Other E Number ofsStru es
-�v. '� • -
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes PNo ❑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 INo ❑NA ❑NE
2, Is there evidence of a past discharge from any part of the operation? ❑Yes No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes�/No ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued `

f
Facility Number: Date of Inspection 3
Waste O+ollection &Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes eNo ❑NA ❑NE
a. If yes,is waste level into the structural freeboard? ❑Yes ❑No ❑NA ❑NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes L3 Ro ❑NA ❑NE
(iel 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 f2'No ❑NA ❑NE
8:-Do any of the stuctures lack adequate markers as required by the permit? ❑Yes pMo ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes P'Ro ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes .0"No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes LNo ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑ PAN> 10%or l0 lbs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes E?f�o ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes ON- ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes 0No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes E N ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes J2/No ❑NA ❑NE
'Comments(refer to question#) Explain any YES answers and/or auy-recommendations or any other comments
Use dra ings 4facility.to better explain situations.(rise additional pages as`necessary). w 3
Reviewer[Inspector Name Phone:
Reviewer/]nspector Signature: Date: 3 d
Page 2 of 3 1128104 Continued

Facility Number: a — Date of Inspection 3
Required Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes 1�3`No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes 5YNo ❑NA ❑NE
the appropriate box. ❑W­Up ❑Checklists ❑ Design ❑Maps El 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 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 ;;PNo ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes JZNo ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes j2No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes BNo ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes Mo ❑NA ❑NE
Other issues �,/�
N
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes O o ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes �No ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes Zo ❑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 XNo ❑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 J2-No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes L3/No ❑NA ❑NE
Additional Comments and/or Drawings: -
� yto 1 . 7
l
Page 3 of 3 12128104

J
iviAon of Water Q arty ...
Facility Number ! Q Division of Soil and Water Conservation
u QM
x,
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitA!(Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l Arrival Time: Departure Time: County: Region:
Farm Name: CJ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ! Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o Longitude: o
i
v Design Current Desi o Current 3 Design Current
Swine Capaerty_ Po Mahon Wet Poult `'' ' "'
_ p ry �CapacitvPopulahon -��CattleCapacty Population
❑Wean to Finish ❑Layer :❑Dairy Cow
r
❑ Wean to Feeder ❑Non-Layer I Dairy Calf
El Feeder to Finish ,b ❑Dairy Heifer
❑Farrow to Wean El Dry Cow
Dry Poultr3 §w.,
❑Farrow to Feeder �'' """' �""L W"�El Non-Dairy
❑Farrow to Finish ❑Layers ❑Beef Stocker
'❑Gilts „❑Non-LayersEl =Pullets ❑Beef Feeder
El Boars ❑Beef Brood CouA
44 'Lj 1 urke s . ..
Others .
�� r . -❑Turkey Points
1 ❑Other I ❑Other
— 4 Nu beraf Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes ZNo ❑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? El Yes 'XO
510
El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes ❑NA ❑NE
other than from a discharge?
Page I of 3 12128104 Continued

Facility Number: :,AEVDate of Inspection
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
Struclt re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes No ElNA ElNE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes 0 No ❑NA ❑NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes .0 No ❑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 VNo ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes E�No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes A No ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑ Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑ PAN> 10%or 10 Ibs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes XNo ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? 'Yes ❑No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application? ❑Yes ;3"No ❑NA ❑NE
18. is there a lack of properly operating waste application equipment? [:]Yes 21�No ❑NA ❑NE
'Comments(refer to question'#): Explain any YES answers and/or any recommendations or any other commenis F:
Use drawiri s-of facie to better-;ex lain.situatrbns. use additional a es as necessa
., Q }�� f l: i{'iiiA-PPn3L.'Ny-.S f.
66n fly Per on AL
Reviiewertinspector Name Phone: Lei
Reviewer/Inspector Signature: Date: "
Page 2 of 3 1028104 Continued

Facility Number: r' Date of Inspection -
Required Records& Doca 2ents
19. Did the facility fail to have Certificate of Coverage& Permit readily available? ❑Yes gNo ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes )r,3No ❑NA ❑NE
the appropriate box.
❑WUP El Checklists [I Design El Maps ❑Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes ❑No ❑NA ❑NE
El
Waste Application/LJJ6Veekly Freeboard [I Waste Analysis ❑ Soil Analysis El Waste Transfers El Annual Certification
( infall ❑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 EJ No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes tj No ❑NA ❑NE
99-
. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No ❑NA El NE
2 Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑No ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes ❑No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes OPNo ❑NA �NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes J'No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑yes g-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 oNo ❑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 ZNo ❑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 J;2'No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑ Yes _�KN o ❑NA ❑NE
Additional Comments`and/or,Drawings:
�� `
lam/ �L/
Ilk
ns e17
d4/ 6 fur /..,- , 7VV At,
: y
-fet,_ /a 910-3 S_o- OooV ��u � ` r`` s-s
Page 3 of 3 12128104

,' Division of Water Quality
Facility Number /Q Division of Soil and Water Conservation
EQ Other Agency
Type of Visit_,JO�Co—mpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason:for Visit O Routine O Complaint O Follow up Q Referral Q Emergency O Other ❑ Denied Access
,
Date of Visit: .S Arrival Time: l!�/eAo�__. eparture Time: County: Region:
.r
Farm Name: :� L.i_ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: l Title: Phone No:
Onsite Representative: �A, /��r.4 Integrator:
Certified Operator: Operator Cerofication Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o Longitude: o
Design Current Design Current Design Current;,"
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity- Populations
❑ Wean to Finish T EE01
La er ❑Dai Cow
ElWean to Feeder Non-La er El Dairy Calf
❑ Feeder to Finish ❑Dairy Heifej
❑ Farrow to Wean Dry Poultry ❑ DryCow
❑ Farrow to Feeder ❑Non-Dai
❑ Farrow to Finish ❑Layers
❑Beef Stocker
❑Gilts ❑Non-Layers
❑ Pullets El Beef Feeder
El Boars ❑Beef Brood Co
- ❑Turkeys
Other ❑Turkey Poults
❑Other j JE1 Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes Wo ❑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 ❑�N'o ❑NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes 2I
, 1N ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes No ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes )Zr No ❑NA ❑NE
a. If yes,is waste level into the structural freeboard? [-]Yes ,mil No ❑NA ❑NE
Struc e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes �'�io [INA El NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed El Yes �No El NA El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environmental threat,notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes�No ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes XNo ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks) '
4. 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 ElYeso ❑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 ❑14eavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or 10 lbs ❑Total Phosphorus ❑Failure to incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes ❑ o ElNA ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑YesfNo
El NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑YesEl NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes ❑NA ❑NE
Comments(refer top.question#,): Explainlany YES adsw,ers and/or any recommendations or any other comments.
.r;
Use drawings ofRfactuty.to"tietter explain,situatrons.o(nse>ad."ditional�pages as necessary,): . .
F °1si
Reviewer/Inspector Name J �f Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12/281 4 Continued

Faciljty Number: Date of Inspection
. Required Records& Docume_ts
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes J3'No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes ;'No ❑NA ❑NE
the appropirate box. ❑VVUp ❑Checklists ❑Design El Maps El 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 ❑ t20 Minute Inspections ❑Monthly and 1" Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes R<o ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes JU3 No ❑NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ZNo ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes P3/� N'o El NA El NE
26. Did the facility fail to have an actively certified operator in charge? El Yes Z No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes P No ❑NA ❑NE
Other Issues .�,,//
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes IQNo ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes O No ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes dNo ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately �
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes Z 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 dpqo ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes dNo ❑NA ❑NE
Additifonal,Comments and/or Drawings:
AL
l
7
I2128104

—O"Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit plioutine o Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: '(J(J Departure Time: County: Region:
4 r
Farm Name:07 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: MIA
No:
Onsite Representative: �� Integrator: /�'
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =e Longitude: =o =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑Wean to Finish ❑La er ❑Dairy Cow
❑ Wean to Feeder ❑Non-La et ❑Dairy Calf
❑ Feeder to Finish ❑Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑Dry Cow
❑Farrow to Feeder ❑Non-Dairy
❑Farrow to Finish ❑ Layers
❑Beef Stocker
❑Gilts ❑Non-Layers
❑ ❑Beef Feeder
Pullets
❑Boars ❑Beef Brood Cowl-
Turkeys
Other ❑Turkex Poults
❑Other j ❑Other Number of Structures:
Discharees& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes Z No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does discharge bypass the waste management system?(If yes,notify DWQ) ❑ Yes '3'o El NA ❑NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes WN
❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El yes ❑ NA ❑NE
other than from a discharge?
12128104 Continued

Y*' ��W
i

Facility Number: Date of Inspection
Required Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes ,6No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes PNo ❑NA ❑NE
the appropirate box. ❑WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes ❑No ❑NA ❑NE
❑ Waste Application ❑ Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Annual Certification
❑ Rainfall ❑Stocking ❑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 ,'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 7No ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ONo ❑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 PNo ❑NA ❑NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes P'No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes fiTNo ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? El Yes ONo ❑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 [Ko El NA [I NE
General Permit? (iel discharge, freeboard problems,over application) ✓
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes P6No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes �40 ❑NA ❑NE
Additional:Com�nents�andlbir Drawings f
�. - .w
AL
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31710 7 z
2 _ z
14VI 11r�
�(r
Page 3 of 3 12128104

Facility Number: Date of Inspection
_2�ds" X9Z6*
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes No El NA ❑NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �Z<o ❑NA ❑NE
Stru re 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 FeKo ❑NA ❑NE
(ie/large trees,severe erosion,seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑Yes P?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 PMo ❑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 [ io ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes 1; o ❑NA [3 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes 2No ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or ]O 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 RNo ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes �o [I NA ❑NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes PNo ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes 2 No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes 91, o ❑NA ❑NE
Comments(refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations.(use additional pages as necessary):
A,
Reviewer/Inspector Name Phone: 611r
Reviewer/Inspector Signature: Date: "-
12128,44 Continued

l
0`Division of Water Quality
Facility Number t a .O Division of Soil and Water Conservation
O Other Agency
Type of Visit ,r Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitAE:rRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit: 3 1 Arrival Time:� Departure Time: County: Region
Farm Name: S Z d— it on _ _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: yy'' Title: Phone No:
Onsite Representative: Clnr �5 _\iq,kA, Integrator:
Certified Operator: Operator Certification Number-
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design. Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population_
❑Wean to Finish ❑Layer ❑ Dairy Cow
Wean to Feeder 1,2 600 1
I ❑Non-La ei ❑ Dairy Calf
Feeder to Finish I I Dairy Heifer
❑Farrow to Wean Dry Poultry ❑ Dry Cow
❑Farrow to Feeder ❑ Non-Dairy
❑Farrow to Finish ❑Layers
❑ Beef Stocker
❑Gilts ❑Non-Layers
❑ Pullets El Beef Feeder
❑Boars El Beef Brood Co j
- - ElTurkeys
- -
Other ❑Turkey Poults
❑Other ❑Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes ❑No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑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 ❑'No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes C�No ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number: 3 -- 8 ' Date of Inspection 3 /1
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes g No ❑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):
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 RNo ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes ErNo ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes O'No ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes ❑"No ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes O"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 0 No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes [3No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑Yes M-No ❑NA ❑NE
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 �'No ❑NA ❑NE
Comments(refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations.(use additional pages as necessary):
Reviewer/Inspector Name i�aPhone: d— 17- '5%;t
Reviewer/Inspector Signature: Date: I 1
12128104 Continued

Facility Number: 3 — Date of Inspection 111 �
Required Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes J2"No ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes 4TNo ❑NA ❑NE
the appropriate box.
❑WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement?If yes,check the appropriate box below. ❑Yes [[2'No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑Waste Transfers ❑Annual Certification
❑Rainfall ❑ Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and I"Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes 0 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 ,ONo ❑NA ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes PjNo ❑NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes P No ❑NA [:1 NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ❑No ❑NA E]NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes [3'No ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes PkNo ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes ❑'`No ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes I�Y&o ❑NA ❑NE
General Permit? (ic/discharge,freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes VNo ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes [%No ❑NA ❑NE
Additional Comments and/or Drawings:
IA/,4- ,t/
Z: 5--
2-
Cc, ff e CX 'r"-
Q
12128104

►y
=19ty,
vision of Water Quality
umber 31 O Division of Soil and Water Conservation
0 Other Agency
Eof Visit �"ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit: 3 Arrival Time:r Departure Time: County: Region:
Farm Name: �� 1tt__ - Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: /mil P Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 Longitude: °
r
Design Current Design Current .. ': Design Current
Swine Capacity;''Population,; Wet Poultry Capacity Population Cattle Capacity Population'`
❑Wean to Finish ❑La er ❑Dairy Cow
Wean to Feeder G (1 ❑Non-La er ❑Dai Calf
--
❑Feeder to Finish ❑Dairy Heifer
❑Farrow to Wean Dry Poultry ❑Dry Cow
❑Farrow to Feeder E]Non-Dairy
❑Farrow to Finish ❑Layers
❑Beef Stocker
❑Gilts ❑Non-Layers
❑Boars
El Pullets ❑Beef Feeder
❑Turke s ❑Beef Brood Co
Other ❑Turkey Poults
❑Other ❑Other Number of Structures:
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes _ 3 No ❑NA ❑NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does 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-15 No ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes eNo ❑NA ❑NE
other than from a discharge?
Page 1 of 3 12128104 Continued

Facility Number: 3 -a Date of Inspection
Waste Collection &Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes j2^No ❑NA ❑NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑No ❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): U
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes G No ❑NA ❑NE
(iel 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 �JNo ❑NA ❑NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes E; 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 J:l-No ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑Yes ONo ❑NA ❑NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes,check the appropriate box below, [I Yes EJ No ❑NA ❑NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
❑PAN ❑PAN> 10%or 10 Ibs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes 00'No ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes E_'fNo ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑Yes R No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑Yes 2No ❑NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes F�_-FNO ❑NA ❑NE
Comments(refer to question ft Explain any YES answers and/or any recommendations or:any other comments.' `
Use drawings of facility to better explain situations.(use additional pages as necessary)-
7-te��Qi'o��m
Reviewer/inspector Name I —- -- - _ 1 Phone: lG- 7 6=7
Reviewer/Inspector Signature: A Date: 3
Page 2 of 3 121f8104 Continued

Facility Number: 31 — Date of Inspection
Required Records&Documents
19. Did the facility fail to have Certificate of Coverage&Permit readily available? ❑Yes ONo ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes,check ❑Yes ,0 No ❑NA ❑NE
the 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 I"Rain Inspections ❑Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑Yes P'No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑No Lj-fq'A ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No P,11A ❑NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑No [I-NA ❑NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes g No ❑NA ❑NE
27. Did the facility fail to secure a phosphorus loss assessment(PLAT)certification? ❑Yes ❑No ❑NA 19-NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑Yes AaNO ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes -ff 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 PNo ❑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 LJ No ❑NA ❑NE
General Permit? (ie/discharge,freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes Q-NO ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes E2 No ❑NA ❑NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

,. n ¢ Division of Water-Quality
c3 O` O
Number D Division oC Soil and Water Conservation
Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vis' 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ,: `� O. Arrival Time: Q Departure Time: County: Region: I,
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone
,,No:
OnsiteRepresentative: C�nr1s 1"� [Q� Integrator: �wY1�YWl
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o =1 Longitude: 0 0 =6 = i1
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
Wean to Finish ❑ Layer ❑ Dairy Cow
❑ Wean to Feeder ILI Non-Layer I I ❑ Dairy Calf
❑ Feeder to Finish ❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder ❑Non-Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑Gilts ElNon-Layers
❑ Pullets ❑ Beef Feeder
❑ Boars ElBeef Brood Cowl
-— ❑Turkeys - - - - -
Other ❑Turkey Poults
❑Other �I
❑Other Number of Structures: �
Discharges& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes JJ No ❑NA ❑NE
Discharge originated at: ❑ Structure ❑Application Field ❑Other
a. Was the conveyance man-made? ❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State?(If yes,notify DWQ) ❑Yes ❑No ❑NA ❑NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does 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 ETNo ❑NA ❑NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes ,"No ❑NA ❑NE
other than from a discharge?
12128104 Continued

Facility Number:3 Date of Inspection U
Waste Collection & Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑Yes ZNo ❑NA ❑NE
a. If yes,is waste level into the structural freeboard? El Yes ❑No ❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 02
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes L�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 EMo ❑NA ❑NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes ONO ❑NA ❑NE
(Not applicable to roofed pits,dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes 2<o ❑NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ErNo ❑NA ❑NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes,check the appropriate box below. ❑Yes Er No ❑NA ❑NE
❑Excessive Ponding ❑Hydraulic Overload ❑Frozen Ground ❑Heavy Metals(Cu,Zn,etc.)
[]PAN ❑PAN> 10%or l0 Ibs ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into Bare Soil
❑Outside of Acceptable Crop Window ❑Evidence of Wind Drifl ❑Applicdatigrf tside of Area
12. Crop types) 101t
(fv 6o'A
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes RNo ❑NA ❑NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes [ No ❑NA ❑NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]Yes J2 No ❑NA ❑NE
17. Does the facility lack adequate acreage for land application? ❑Yes .0 No [:1 NA ❑NE
18. Is there a lack of properly operating waste application equipment? ❑Yes 2Io ❑NA ❑NE
as( x, ,y q Fa P lain an YES(swers�and/ur A grecommem`n a_h nS oo an other co y} r y Gomments�referrto uestton#} `p y '° y `�'�`�'�' mmen#s.
Use drawin of�facilt to better ea iatn s�tu'attons : use addthanal a es as necess „-
Reviewer/]nspector Name 6 lPhone• U 3 r-
,3700
Reviewer/Inspector Signature: Date: Gam"
1212810 Continued

Facility Number: — Date of Inspection
`Required Records&Documents
19. Did the facility fail to have Certificate of Coverage& Permit readily available? ❑Yes XNo ❑NA ❑NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑Yes ANo ❑NA ❑NE
the appropirate box. ❑WUP []Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes,check the appropriate box below. Yes ❑No ❑NA ❑NE
❑Waste Application ❑Weekly Freeboard XWaste 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 m No ❑NA ❑NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑No ;21'NA ❑NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑No ❑NA 121 E
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑Yes ❑No ❑NA ETNE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes 2No ❑NA ❑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? ❑Yes 2rNo ❑NA ❑NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑Yes &No ❑NA ❑NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑Yes eNo ❑NA ❑NE
If yes,contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑Yes ONo ❑NA ❑NE
General Permit? (ie/discharge, freeboard problems,over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes [21No ❑NA ❑NE
33. Does facility require a follow-up visit by same agency? ❑Yes 12 No ❑NA ❑NE
Additional Comments and/or Drawings: l
l J Qu. - t�•�c> uJ -� �e Ce ,1Pe�' ruvyfl rJ��
eve►l+, M �� E' T S Scy,4' a -(:C � S
'.5czrn 0 le- bu+ le Su 1 s eta ve, nG+
o e-d
, ,ok, neR�_ -t r-\ 3 ood o r, c6r
12128104

a Division ofW star ah
- - - - (,>iDivision ofSa�and Water Censietva6on�. '-_
• ;� OOther Ageuc�
Type of Visit Z11
Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ptoutine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number
Date or Visit: � / Time:
3
Q Not Operational O Below Threshold
'Permitted Certified 0 ConditionaIly Certified 13 Registered Date Last Operated or Above Threshold: ........ �-
FarmName: ..... > ...... ..1 ......T.4c. !'a._......._....................................... County: .... ......................... ......................
Owner Name. _ . .� .._ . ...._ ... - Phone No: . . ...... .W..W. ..-. .W .�-_. . . .... . _._.�... .�
Mailing Address: .................................
........ .......................................—................. ................................................................................... ..........................
Facility Contact: ..__ . . . ._... . ._ . .�--- . . ...._ Title- Phone No:
Onsite Representative:,�• 'jam.,._} - •• Integrator:••- (�,r .............
............................_................ ...................
............. -- ...
Certified Operator:. ._ ._�.... ._..._ �_.. ...... ._. .... .... Operator Certification -
Location of Farm:
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude �•�� ��° Longitude �• �� ���
_ s "Current t De5rgu Cnrrent t ` - ` ' DeSlgn -Current
Design
Swine Ca aci .W1?o alation_ Poaltr3'w Ca Po eilahan _ Cattle �,Ca-an ,::Po elation.;
Wean to Feeder 9 Z Layer ❑Dairy
Feeder to Finish ❑Non-Layer 3 ❑Non-Dairy
- 0 Farrow to Wean
:. W � Other
Farrow to Feeder ❑ 3
Farrow to Finish
f Total Des>gn�CaPac�t3'
Gilts a�-
❑Boars i To#al'SSLW
�' ��Number of Lagoons x �-_=
y S.
Discharges&Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes Z"No -
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed,was the conveyance man-made? ❑Yes ❑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 ❑�N?o
2. Is there evidence of past discharge from any part of the operation? [I Yes ,t=1 pro
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes 00
Waste Collection& Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes 2rNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Iden€ifier: ,--- - ___ .. . ._.......• -..._—•...... .................•-•--•._.......... ..... . .
Freeboard(inches):
12112103 Continued

Facility Number: j Date of Inspection
5. 'Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, O&Yes ❑No
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑Yes ino
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 maintenancelimprovement? ❑Yes eNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑Yes ZNo
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level ❑Yes 120o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/unprovement? ❑Yes 0'No
11. Is there evidence of over application? If yes,check the appropriate box below. ❑Yes P�14o
❑Excessive Ponding ❑PAN ❑Hydraulic Overload ❑Frozen Ground ❑Copper and/or Zinc
12. Crop type e
13. Do the receiving crops differ with those designated in the Ce41 red Animal Waste Management Plan(CAWMP)? ❑Yes , Na
14. a)Does the facility lack adequate acreage for land application? ❑Yes Q'No
b)Does the facility need a wettable acre determination? ❑Yes EfNo
c)This facility is pended for a wettable acre determination? [:]Yes j rNo
15. Does the receiving crop need improvement? ❑Yes EfNo
16. is there a lack of adequate waste application equipment? ❑Yes '21�0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑Yes ZNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑Yes 53'No
19. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes 00&o
roads,building structure,and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes,contact a regional ❑Yes PNo
Air Quality representative immediately.
Comments{refer W questeon#) Explarn any Y �andJo%auy recommendaons or oily gfher comuents
LJse dlraw�ngs of facility6to better explain situatons {use addrhonal pages as necessary) ❑Field Copy ❑Final Notes
-»-
s 1 -
h-lf�a 7`� erg slog �rat
Reviewer/Inspector Name r 5z
Reviewer/Inspector Signature: Date: n
12112103 Continued

Facility Number: 3 — Date of Inspection
Required Records&Documents
21. Fail to have Certificate of Coverage&General Permit or other Permit readily available? ❑Yes _;].No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes .,ETNo
23. Does record keeping need improvement?If yes,check the appropriate box below. 'Yes ❑No
❑Waste Application ❑Freeboard P<Vaste Analysis ❑Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ,ENo
25. Did the facility fail to have a actively certified operator in charge? ❑Yes j2llo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes 00
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes J�Mo
28. Does facility require a follow-up visit by same agency? ❑Yes A!rNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes 21go
N IPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit?(If no,skip questions 31-35) ❑Yes fir�a
31. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑No
32. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑No
33. Did the facility fail to conduct an annual sludge survey? ❑Yes ❑No
34. Did the facility fail to calibrate waste application equipment? ❑Yes ❑No
35. Does record keeping for NPDES required forms need improvement? If yes,check the appropriate box below. ❑Yes ❑No
❑Stocking Form ❑Crop Yield Form ❑Rainfall ❑Inspection After 1"Rain
❑ 120 Minute Inspections ❑Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditki ai`Comraents and/or Drawings . . =
93, '!'✓��Ssrn Gras ~q�t/r!f/S/,s Vorv, 319 3 3110
3111, J/-'2.Z� 3�a 3 a
/ Po-L
T
12112103

Division 6U%4�4�opli
} , O Divii"OI�.SOI�I and Water Conservatiqu y
Type of Visit 19-Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit J$Routine O Complaint O Follow up Q Emergency Notification O Other ❑Denied Access
Facility Number 3 2$'�}
Date of Visit: ��Time:
NNot Operational 0 Below Threshold
®Permitted ®Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ........
__.. .__.
Farm Name: .�..;f
. jey� n, .z............... St/ ..........................._....................... County: ......Aid!ii:._.......................
OwnerName: .......1..�f..E!'y .......... ............. ...... Phone No: »........................_................................_......
.._... ..._�.
FacilityContact: ...............................................................4..............Title: ................................................................ Phone No: .................................._............
MailingAddress: ................................................ ..................................................................................... ....................
W..
Onsite Representative: 4414 °1.............................................................................. Integrator:....' ................................. �...�..��
Certified Operator:................................................... ............................................................. Operator Certification Number:......:............. ..._.
Location of Farm:
•
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude �'�� ��� Longitude �• �� �«
Design,; Curreutl'. -` Design Current Desrgn''' Cnrre�tt
Swine Ca ac Population.,;. Poultry 'Ciipacity Population- Cattle �Cajiadty.4t pu alatlott-.'
®Wean to Feeder ZG p Z6G�D ❑Layer ❑Dairy
❑Feeder to Finish 10Non-Layer I ❑Non-Dairy
❑Farrow to Wean
Farrow to Feeder ❑Other
❑Farrow to Finish TOE"DeSl ESC1S
❑Gilts P .• _
❑Boars TOIta1,SSL�W-?
Number oIT i.agooas ;❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holduig Ponds/Solid Trups. ❑No Liquid Waste Management System n
Discharees& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes RrNo
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 CNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes CF[No
Waste Collection&Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes RNo
Structure I Structure 2 Structure 3 - Structure 4 Structure 5 Structure 5
Identifier: ................
.................... .................................... ....I....... ..................... ...
Freeboard(inches):
5/00 Continued on back

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes ®,No
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? 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 MNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes M No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes NNo
_Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑Yes 0-No
11. Is there evidence of over application? ❑ExcessiveePPonding ❑APAN ❑Hydraulic Overload ❑Yes %No
12. Crop hype ✓�t ���i �ltv,� 71fri �ti�n 4R
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWNQ)? ❑Yes 9 No
14. a)Does the facility lack adequate acreage for land application? ❑Yes ®No
b)Does the facility need a wettable acre determination? ❑Yes CR No
c)This facility is pended for a wettable acre determination? ❑Yes ZZNo
15. Does the receiving crop need improvement? ❑Yes ®No
16, Is there a lack of adequate waste application equipment? ❑Yes 5�No
Required Records&Documents
17, Fail to have Certificate of Coverage&General Permit or other Permit readily available? ❑Yes [&No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design,maps,etc.) ❑Yes EqNo
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis&soil sample reports) ❑Yes M No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes 91 No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes �No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes ®No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes [Z No
24. Does facility require a follow-up visit by same agency? ❑Yes ®No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes No
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Comments.(refer to queshtiii#:' Explam.aity YE&ainswers andlorii "any recommeudahons or any other comments-."
Use dlrawings offactlybettereiplal tn .( seddainlpgeaso
❑Field Copy ❑Final Notes
!hC S�k/t_(/G1 bod "5 bv'I'Zfhy 1>J4 i `�� 7v h Ae_ �5cvh . 1 /&4Aw �}5 l�i�l llP��c )40
.( /
/61 e />oS1-a�7AO 6&-m vY 4a nwolf o/e in zo-11- .
w
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: — Date of inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 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 [KNo
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 MNo
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 Q�No
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes 21 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑Yes kNo
Additional omments.and/orDrawings: -
w
5100

Division of Water Quality-, ` .
Q Division of Soil and Water.Conservateoa
r
0 Other A"
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number
Date of Visit: .3 7- �� Time: t11� Printed on: 7/21/2000
3 Z
Q Not Operational Q Below Threshold
Arpermitted ©Certiifiieed [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ....................
Farm Name: J�'r✓1 .�6i'` tJrs� County: L! ... ! ..................................... ......................
OwnerName: .............n.......7.............14 ........................................................... Phone No: .......................................................................................
FacilityContact: ..............................................................................Title: ........................................................I....... Phone No: ...................................................
MailingAddress: .............................................................. .....................................................................................................,,............ ........................... ..........................
Onsite Representative:..... ... .... . �... ................................. Inte ratort.py F �"S-
... . ......... ~
Certified Operator:................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Swine ❑Poultry ❑Cattle ❑Horse Latitude �•�� �« Longitude �•�� ���
DestgR; Current " Design . Current Design Current
Capacity Population Poultry Cauacitv Population Cattle , Ai elation_
can to Feeder Zb 0 0 ❑Layer I I ❑Dairy
Feeder to Finish -Layer ❑Non-Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total DeO& CapaClty
Gilts
r Boars Total:SSLW
Ntgrtilietc;of Lagoons ❑Subsurface Drains Present ❑Lagoon Area 10 Spray Field Area I-'
Holditg.Poiids/Solid Traps:' ❑No Liquid Waste Management System
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes YNo
Discharge originated at: [ILagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made'? ❑Yes O No
h. If discharge is observed.did it reach Water of the State?(If yes, notify DWQ) 0 Yes No
c. If discharge is observed. what is the estimated flow in gal/min? M l
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 :o No
Waste Collection &:Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑ Spillway ❑Yes O No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................... .................................... ................................... .................................... .................................... ....................................
Freeboard(inches): Z
5100 Continued an back

Facility Number: 31 —Z 84 Date of Inspection ��� Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes N0
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes No
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑Yes O No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes j6 No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level fl,.�(
elevation markings? ❑Yes `P No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes W No
IL Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Hydraulic Overload ElYes XX No
12. Croptype _ 6rn �l�'1> ,Soy bcgtn-Jj Ay,-hoic"- An'?t(q ) --
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes A No
14. a)Does the facility lack adequate acreage for land application? ❑Yes 4�rNo
b) Does the facility need a wettable acre determination? ❑Yes ONO
c)This facility is pended for a wettable acre determination? ❑Yes IQ No
15. Does the receiving crop need improvement? ❑Yes A No
16. Is there a lack of adequate waste application equipment? ❑Yes -0 No
Required Records &Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes 'A No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design, maps,etc.) ❑Yes ]No
19. Does record keeping need improvement?(ie/irrigation,freeboard,waste analysis& soil sample reports) ❑Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes -RI No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes 19No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge,freeboard problems,over application) ❑Yes 1KNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative'? ❑Yes '�No
24. Does facility require a follow-up visit by same agency? ❑Yes JS No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes PrNo
Rio'*61 'tigris;or deficieitcies-were poted during thls;visit; Yoij wiiI reeeiye Rio furthg
corres onc�ei i abi 'i this visit:
Com ents.(refer to question#): Explain any YES answers and/or any recommendations orany other comments'
Use dra of facli to'lietter explain situations use additional es as neces
w
gs ty: P _ t _m. -_ Pam. �a
FA_ t. f 4 y Aind reeo4,< veY'7 wdl jk6ey G,m A.
•
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 3 Z 0 5/Ot7

Facility Number: 71 —2-.0 Date of Inspection 1 3
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 PTNo
28. Is there any evidence of wind drift during land application? (i.e.residue on neighboring vegetation,asphalt, ❑Yes Iff 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 J9No
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
Additional:Comments:and/orDrawings:
T

. .� �" � :.��, � � �°.� � _ • Q Drvrsion of Soil and Water.Conservatron.` - � �:�. � -� '-
�
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑Denied Access
Facility Number Date of Visit: ime: Z. Printed on: 7/21/2000
Q Not Operational 0 Below Threshold
Permitted ©Certifi d ©ConditionallyZ)�s
ified 0 Registered Date Last Operated or Above Threshold: ..............
Farm Name: ............ . . �✓I w (`r , ek County': .........bbp.................................... ......................
, / ........ .......................
o AOwner Name: ..... �1.: ........�lf..r - ^'......... iQ s ....... Phone No: ........ .. . ........... ..... ................
Facility Contact: ........("(............. ........ .r ...........Title: ........Q llV.. Phone No: .... ll . 7.A..fp.........
Mailing Address: .......... �� WC/�L�.......1���pu....��..'.........��i��-��.U`.u'�.................... .��...`...1.................................................. �Jl ,
Onsike Representative: Integrator: .!-/�/��
.. .""""....;r ... "l'.............. ....... ....................... ..... ............
Certified Operator:,,,,,,,,,,,.Ah.}j,�-.,!......L l �'� Q"7 ..--_ -- Operator Certification Number:......, 1.5. .........
Location of Farm:
C<S-k /57
r Ale,
❑Swine ❑Poultry ❑Cattle ❑Horse Latitude Longitude �• �� 0"J
Design Current Design Current Design Current
Swine Canacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder Z Z) ❑ Layer ❑Dairy
❑Feeder to Finish JE1 Non-Layer ❑Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other
❑Farrow to Finish Total Design Capacity
❑Gilts
❑ Boars Tota155LW fj bn
Number of Lagoons ❑Subsurface Drains Present ❑Lag-on Area ❑Spray Field Area
Holding Ponds/Solid Traps ❑No Liquid Waste Management System
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes E4 No
Discharge originated at: ElLagoon ElSpray Field ❑Other
a. If discharge is observed, was the conveyance Irian-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 limy in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes ❑No
2. Is there evidence of past discharge from any part of the operation? ❑Yes It 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 &,rreatinent
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes ❑No
St e/I Structure 2 Structure; Structure 4 Structure 5 Structure 6
Identifier: . ..�r ,:,...............
Freehoard (inches):
5100 Continued on back

Facility Number:31 -- Date of Inspection O / Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, ❑Yes ii No
seepage,etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or 1
closure plan? El Yes 16 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 l No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑Yes No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes O No
11. Is there evidence of over application? , ❑Excessive Ponding ❑PAN ❑Hydraulic Overload ❑Yes [�No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ElYes No
14- a)Does the facility lack adequate acreage for land application? ❑Yes No
b)Does the facility need a wettable acre determination? ❑Yes 16 No
c)This facility is pended for a wettable acre determination? ❑Yes FA No
15. Does the receiving crop need improvement? ❑Yes dNo .
16. Is there a lack of adequate waste application equipment? ❑Yes [/No
Required Records&Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑Yes D(No
18_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design, maps,etc.) ❑Yes WNo
19. Does record keeping need improvement?(ie/irrigation, freeboard,waste analysis&soil sample reports) ❑Yes 91No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes U(No
21. Did the facility fail to have a actively certified operator in charge? ❑Yes Q1 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit? ,,,,,,((
(ie/discharge, freeboard problems,over application) El Yes fI No
23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative'? ❑Yes QrNo
24. Does facility require a follow-up visit by same agency? ❑Yes ,VJ No
25. ere any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes [(No
1dMoti6isor•difci6nd,ts•mer h6fed-i Bein this;AAC-Yoxwll•ieee ii furthr� a e i . :
. . . . :i: ey : : : : : : : .corres oridetce: bau�thvsi . . . . . . . . . .
Comments(refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations.(use additional pages as necessary):
4AD� 7-0
IMI
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

Facility Number: — Date of Inspection Printed on: 7/21/2000
..Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or Iagoon fail to discharge at/or below ❑Yes VNO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑Yes 16 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 dNo
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
Additional-Comments an orDrawings:
AL
5/00

vision of Soil andWater;Conseivat<on peration
ODivision of 5oi1 and Water Conservation Compliance Inspection
Division of Water QuaLty C 4 > s
M ompliance Inspection
i
_-
D Other Agency_ Operation Review M = r
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 4Q 24 hr.(hh:mm)
©Permitted Certified Q Conditionally Certified [3 Registered 10 Not O erational Date Last Operated.
FarmName: ..... �rJ`�'-1--. ............. ............................................. County: ........ ��t ..................-........ .......................L__ N....
Owner Name: ................................................... Phone No:
FacilityContact: ..............................................................................Title: ................................................................ Phone No:
Mailing Address:
Onsite Representative: V�la� .......................... Integrator:.... �1�-•............................ ................................................ ............ . -.
Certified Operator:................................................... ............................................................. Operator Certification Number:..........................................
L ti n'of a m:
G.. �Si 4. :..........G ... S� ........................................................................... A,
.......---
Latitude �� �" Longitude
;. Design Current :" . '' Design Current= . Design` . Cue rent
CSwine Ptry io attle
_Ca0acity Populationoncy; Caacity P
Wean to Feeder cx) -;,❑Layer ❑Dairy
❑Feeder to Finish JE Non-Layer ❑Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ` ❑Other
Ly Farrow to Finish = Total Design Capacity
❑Gilts, 7,11
❑Boars --T6ta1-SSL"W
Dumber of Lagoons - ❑ ent Subsurface Drains Pres ❑Lagoon Area 10 Spray Field Area
Holdeng=Pondsa Solid Traps 0 ❑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 D�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes 9No
Waste Collection & Treatment
4. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Spillway ❑Yes 1No
+ Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): a' + .................................. ................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed?(ie/trees,severe erosion, (:]Yes ;yNo
seepage,etc.)
3/23/99 Continued on back
i

' Facility Number: 3� —a�� Date of Inspection C�
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes (,XNo
(If any of questions 4-6 was answered yes,and the situation poses an
immediate public health or environmental threat,notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑Yes kNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑Yes (%No
9. Do any stuctures lack adequate,gauged markers with required maximum and minimum liquid level
elevation markings? ❑Yes [NtNo
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑Yes XNo
11. Is there evidence of over application? ❑Excessive Ponding ❑PAN ❑Yes RNo
12, Crop type So, l„Fo�,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan(CAWMP)? ❑Yes No.
14. a Does the facilitylack adequate acreage for land application? ❑Yes to
9 � PP
b) Does the facility need a wettable acre determination? ❑ Yes g No
c)This facility is pended for a wettable acre determination? ❑ Yes MNo
15. Does the receiving crop need improvement? ❑Yes �No
16. Is there a lack of adequate waste application equipment? ❑Yes f4 No
Required Records &Documents
17. Fail to have Certificate of Coverage&General Permit readily available? ❑ Yes 9No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP,checklists,design, maps,etc.) ❑Yes tgNo
19, Does record keeping need improvement?(ie/irrigation, freeboard, waste analysis&soil sample reports) ❑Yes WNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ONO
21, Did the facility fail to have a actively certified operator in charge? ❑Yes ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application) ❑Yes M No
23, Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes Dq No
24. Does facility require a follow-up visit by same agency? ❑Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes (XNo
0:Rio yiolaticjns:ot.& ciendo$44, ria noted doling�his:visit:,'Y:oir will reoeiye Rio futth0.:-
corres oric]!ence:a�o�ut this:visit: : : : :':':': : : : : : : : : : :': : : : : : : :
Comments(refer_to question#) -,Explain,any YES ansW.ers and/or any reeo."inmendat�ons or.any other comments: ,
Use ilrawrngs of facility to better explain situations (use addituinal"pages as'necessai. -
ry
` W
-..m _ .. a
Reviewer/Inspector
Name
g 3�Y7_
Reviewer/Inspector Signature: Date: a�
3/23/99

Date of Inspection
Facility Number: 3
Odor Issue's
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑Yes gNo
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 b�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 9No
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
'Nddt ona ommenA an_ ar rawings: t.' e
3/23/99

f
❑Division of Soil and Water Conservation ❑Other Agency p
Division of Water Quality 0 {
O Routine O Complaint ® Follow-up of DW inspection O Follow-tip of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection l �] 24 hr.(hh:mm)
Registered ®Certified ©Applied for Permit 13 Permitted 13 Not Opera Date Last Operated:.
Farm Name: .... i ti Q^........l�.u.;E- ......l.. ................ County:....�].�.1.�..� �............................... .�1.t..�,' �..
Owner Name. V ........ Phone No: 1. . ...........
Facility Contact: .......................... Title:.................... Phone No:
...................................... ...................................... ...................................................
IL
Mailing Address: ....P:.. ..:... .o. .......M._ ..........:. ............................. - -�rz -ri.S.l1 i. ,r.. .................. .. .
Onsite Re resentative: _Q... Z...v,t.. . h.. .. Inte rator:.. ......v.-�- - -..
p �� � ,r h
�c JJ
Certified Operators..... s�.t .�. ... ..:... .... . . ................................�.. � .. - �......... ................. ........... Operator Certification Number,..-... .�.-..
Location of Farm:
.1�J.1c�....r..�.r..tln....S.f:.t�:...0. .......... . . .).. ..... ... ......a..- �..�4.X.i..t^..^..d::..... �.....!.^..'�:�...1�...,a.y.,r_.�'4......$.�.... ... ...... �
�. ..Q. ........................................ .... ....................Latitude ©•�� oo�l�� Longitude �• ` ®"
DesignCurrent Design
Current ;Design Current a
Swme �Capacity Population Poultry Capacity Population Cattle Capacity-Populatiaa
Wean to Feeder Z ❑Layer ElDairy
T ❑Feeder to Finish ILI Non-Layer I I ❑Non-Dairy
❑Farrow to Wean
e
x El Farrow to Feeder
❑Other
❑Farrow to Finish Total Design Capacity" Z 6 0 0
❑Gilts
❑Boars Total S V g 0 '
Number`of Lagoons/jkoidiii ID Subsurface Drains Present ❑i.agoon Area JCI Spray Field Area
3 Ff =a ❑No Liquid Waste Management SystemAM
General
L Are there any buffers that need maintenancelimprovement? ❑Yes ❑No
2. Is any discharge observed from any part of the operation? ❑Yes ❑No
Discbarge 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 oal/min?
- d. Does discharge bypass a lagoon system'?(If yes,notify DWQ) ❑Yes ❑No
3. Is there evidence of past discharge from any part of the operation? ❑Yes ❑No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes ❑No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes ❑No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ❑No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes ❑No
7/25/97
Continued on back

acility-Sutnber:3 —Z
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes ❑No
Structures(l.agoons,11oiding Ponds,Flush Pits.etc )
9. Is storage capacity(freeboard plus storm storage) less than adequate? IN Yes ❑No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:. .........) t
Freeboard (fty ....................................
10. Is seepage observed from any of the structures? ❑ Yes ❑ No
11. Is erosion,or any other threats to the integrity of any of the structures observed? [I Yes
❑ No
12. Do any of the structures need maintenance/improvement? ❑Yes ❑ No
(If any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'? ❑Yes ❑No
Waste application `
14. Is there physical evidence of over application'? ❑ Yes ❑No
(If in excess of WMP,or runoff entering waters of the State.notify DWQ) _
I5. Crop type ...........................................................................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waite Management Plan (AW,MP)`' ❑Yes ❑No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes ❑ No
18. Does the receiving crop need improvement? ❑Yes ❑No
19. Is there a lack of available waste application equipment? ❑Yes ❑ No
20. Does facility require a follow-up visit by same agency? ❑Yes ❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes ❑No
22. Does record keeping need improvement? ElYes ❑,,No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes ❑No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ❑No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑Yes ❑No
0 No.violations or deficiencies were noted duriing this.visit. :You.wi11 receive no further
`. cot�respondenceabautthis'.visit:• :--: - . .• . : .• •- . . . .• .• •:• : - : :• • .
Comments`(refer'to quest.inin#): Explain any Y ES answers and/or any recommendations.or any other comments
Use drawings of facili#y to hkfer explain situations.(use additional pages as necessary)
r
C-v l t n.,a V~ v i s i t W a-s r►,,o- d-e- a.S eS s Q �� 1-t-4 S 6•� w o cLa- -..� u a
t h e S S a �-k 't 0 f � a I-, , w�a vJ 0-1 i,•, �"
sk- K- i-o i—�t } c� o o �, . �► .i
I\T%. l I 1�0-�- v s 1v-e� `E"�Q- ►�t�e �t d d`''��V `�cs r ".
r d S w-t r--e t,2 S f—r V [ �r� p WO e t,r
v C.� + ,�e S r L U.`} p "wC vL
1 7/25/97
fl
Reviewer/Inspector Name
t
Reviewer/Inspector Signature: Date: 'Z q

axes � 3
_ 0 Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality µ� h
u w «.: '
Q Routine O Complaint 0 Follow-u 'of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection Z
Facility Number ' Time of Inspcction 24 hr.(hh:mm)
Registered 13 Certified 0 Applied for Permit 0 Permitted 10 Not Operational Date Last Operated: ..........................
Farm Name: .,T...... .�._4. Y- .....+�.1..�?..Y.I.t_.. County:.... .l.r.. . .+.cI............................. ..W..t.. Z
V
OwnerName:.................... w-� . ............ .... .ra. .. ............................................. Phone No: ... a..l.. .. .. a..i..-----Q..0-If..............I..........
Facility Contact: ........................ . ..Title Phone No:
Mailing Address: .. .:..Q..:..... .Y,.......5IS.............................................................. ..K.e_.VUL..y&1S..Y..1...Elf— !`1.. ............. .�.�..,�
OnsiteRepresentative:. O-ev ... .;;.. .�.. . ...�-u SS.i.. r. .......... Integrator:....U.u..r..p..k.I
Certified Operator;.... ,;.�} a-�. . s....r.:.... ....4:tt_1...:+ ............................ Operator Certification Number:........ ..
Location of Farm:
1�vL.....ln.4.Y.... . . .....5:.(.t ,.....A. ......,�. .. �.r�..f.•.•.t�.�a•�a•.xn.1Cl.rnq,. .... .....&44-+.. *...... .....D .....
�?,... Lsl..l'S•.. .
.... .... az.Q.Q.:.................................................................................................................................................................
Latitude ®•. � OO Longitude =• E110, 0cc
-Desi Current Desig
n gn Current a Design Current
Swine Capacrty.Pgpulation` Poultry " Capacity Population Cattle _` ': Capactty_PopulaGon
Am Wean to Feeder JE1 Layer I I Dairy
❑Feeder to Finish JE1 Non-Layer I ❑Non-Dairy
❑Farrow to Wean
❑ ❑Other
Farrow to Feeder
❑Farrow to Finish "Total Design Capacity Z 6 0
❑Gilts
❑Boars M Total SSLW
-; {� o. �. �
r,
e,
Number of Lagoons/HOld�ng Ponds Q ❑Subsurface Drains Present ❑Lagoon Area I0 Spray Field Area
❑No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑Yes ❑No
2. Is any discharge observed from any part of the operation? ❑Yes ❑No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. if discharge is observed,was the conveyance man-made? ❑Yes ❑No
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) ❑Yes ❑No
c. If discharge is observed,what'is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ❑No
3. Is there evidence of past discharge from any part of the operation? ❑Yes ❑No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes ❑No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes ❑No
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ❑No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes ❑No
7/25/97 Continued on back

Facility Nun, 3
8. Are there lagoons or storage ponds on site which need to be properly closed'? Cl Yes ❑No
Structures(Lagoons.Holding Ponds,Flush Pits,eti.)
9. Is storage capacity(freeboard plus storm storage) less than adequate? ❑Yes ❑ No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _....--.I......1..S............. .................................... ..........I"..........I........... ................................... ..................---..............
Freeboard {fty .................................... ...........
t0. Is seepage observed from any of the structures? ❑ Yes ❑ No
11- is erosion, or any other-threats to the integrity of any of the structures observed'? ❑Yes ❑ No
12. Do any of the structures need maintenance/improvement? ❑Yes ❑ No
(If any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes ❑ No
Waste application
14. Is there physical evidence of over application'?-- ❑Yes ❑No
(If in excess of WMP,or runoff entering waters of the State,notify DWQ) _
15. Crop type ..... ................................I......._.-...................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMPP ❑Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application.? ❑Yes ❑No
18. Does the receiving crop need improvement? ❑Yes ❑No
19. Is there a lack of available waste application equipment? ❑Yes ❑ No
20. Does facility require a follow-up visit by same agency? ®Yes ❑No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes ❑No
s
22. Does record keeping need improvement? ❑ Yes El No
For Certified or Permitted Facilities Only
23, Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ❑No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ❑No
25, Were any additional problems noted which cause noncompliance of the Permit'? ❑Yes ❑No
❑ No.violations or deficiencies were-noted during this:visit.- .You.will receive no further
cotresp6ndence about this visit:-
C6mments`(refer:tn question#) .>Explain any YES answers and/or a'nv recommendations or any''ther comments
Use:drawings of factU4y to better explain situations.(usc additional pages as necessary)
Fv 04 w Q v I d` wo-I aSStSs prv� _4s oK VJ&4 k cG�a-x u� .CJ .`t.Gi _
ij co-++M1S i r4 f-o {�v► a m R-d i b v C o- o� tj
►rep tr t5 ,� �.-e,d a+ w s. c w s P u �r b r1.c 0V, t-r
04
w is vi s s # o s t-v v-e.4 i i Q d� d t �, . f Q v~ - S i
W D i,,i i- v c f-Q p V, r .n/a S i-4r b t L C 4-0 l�-q 0 0 v% p rr
o -5 S �tlLtL ets+n ck- �S X" d,.. - �t v *-L S e%, �,.{-r Vk-2 t�eYa S 7lf 19q
Inrt v� r I Z W Q S +'
Reviewer/Inspector Name t T X
Reviewer/Inspector Signature: Date: 1 q

Facility Number:_.,.... . ..—.. r..g.. Date of Inspection: Z 2
Additioaat Conuneits an or Drawings
v w.x—c� {—r �a �s ° n S w n�XZ b vt w k-t " i
b
4/30/97

0 Division of Soil and Water Conservation ❑Other Agency m�
,� ®Dtvtston of Water Quality � *� ,� �' ��
z
® Routine 0 Complaint 0 Follow-u "of D'l'4' ins action 0 Follow-u of DSWC review 0 Other
Date of Inspection L r q
Facility Number
Time of Inspection t}: 0 a 24 hr.(hh:mm)
©Registered ja Certified 13 Applied for Permit ❑Permitted Not O erational Date Last Operated:
Farm Name: .... .u.y. x� ................................. .V�1..M...�
..���.�r.•a`.q�.�t,.� ,�.�.u.rs:�...r..y ....... ... County:....�
Owner Name:...................L1�la.c►.,C..�1.......... .... .1g..5{. ..` ... Phone No: 9..1-bA...Z.31 Q .31................
FacilityContact: ................................Title:................................................................ Phone No: ...................................................
Mailing Address: ..P..:..0....... .o.X.......$. ..... .......... .Z ..Y..`�....
Onsite Representative:-LickL
.......�..SS.x.�:?��..R..s%�.b.�.�..4:h.... . ....,5.. . ........... Integrator:...M..11..?f...F. .y.....................................................
Certified Operator .----„ ' I
p .. l.�.q.�.�. .......F:.... ......t 4-5.. ................................ Operator Certification Number:....}..`�...�.... ... .._........
Location of Farm:
Qx%.... ..... 4.. �. �....4 �..A.....va "r.. ' ......Q
y. ! �.c i.�.• ......vs�i. :....,�..........3....Q...................................................................................................... ...........................................................
Latitude ©•: .p Z O O Longitude ' "
Design , Current Design „Current Design . Current
Somme Capaeity Population Poulfry (Capacity :Population Cattle ;,"'' Capacity'1?opulation ->
Wean to Feeder 2,C 0Q 10 Layer I I Dairy
M.
❑Feeder to Finish 10 Non-Layer ❑Non-Dairy
❑Farrow to Wean
❑Farrow to Feeder ❑Other
f ❑Farrow to Finish Total`DeSlgn CapaCltys Z c 0 o
❑Gilts
El Boars ;` Tota1..SSLW 7ff no
Number of Lagoons/Holding Ponds,e 0° ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
No Liquid Waste Management Sys❑ tem r ,
General
1'. Are there any buffers that need maintenance/improvement? ®Yes ❑No
2. Is any discharge observed from any part of the operation? 0Z Yes ❑No
Discharge originated at: ❑Lagoon' RSpray 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) JR Yes ❑No
c. If discharge is observed,what'is the estimated flow in "al/min?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes ZNo
3. Is there evidence of past discharge from any part of the operation? ❑Yes [3 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes ®'No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ®Yes ❑No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ®No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes RNo
7/25/97
Continued on back

Facility Number:, —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes, J$No
Structures(Lagoonsfflolding Ponds Flush Pits etc.
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes ®No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -
......J..5.......... ................................... .................................... ................................... ................................... ....I..............................
Freeboard(ft): ....................... ........ ........................... .... ...
10. Is seepage observed from any of the structures? ❑Yes ®No
1 L 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 9 No
(if any of questions 9-12 was answered yes,and the situation poses
an immediate public health or environmental threat,notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes ®No '
Waste ARplication
14. Is there physical evidence of over application? Eff Yes ❑No
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
15. Crop type ..... .............................................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? ❑Yes E4No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes RNo
18. Does the receiving crop need improvement? ❑Yes 13 No
19. Is there a lack of available waste application equipment? ❑Yes ®-No
20. Does facility require a follow-up visit by same agency? CRYes ❑No
21. Did Reviewer/inspector fail to discuss reviewlinspection with on-site representative? ❑Yes EgNo
22. Does record keeping need improvement? ®.Yes ❑No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes 9 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes ONO
25. Were any additional problems noted which cause noncompliance of the Permit? ❑Yes No
13-No.violatio_Mvr deficiencieS..we're noted during this:visiC-You.wifi receive'no ftiritier'.'
Orrrespbndence about this-visit'.
R � _'--�.-„ � � A &R -^�" •iE�k'�.-
#Cvtttamen#.s(refer to question O Ealtlarn any YES savers aitdlot'auy ceconnmen�at ons or any other cotntrrients:
M*:drawt tgof'facihty to better ea plain situations A(use additional p""age as necessaryy
_ - „ ,
t. A jt i Sko,,L4- f 10 e area- S�``� awl teid d� N�• AL
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viewer/inspector Name c, tr � a� `�"viewer/Inspector Signature: Pate:

Facility Number: Date of Inspection:
Additional Connments.and/of Drawings ;
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4/30/97

:®Division of Soil and Water Conservation ❑Other Agency
Division f WaterQuality
:.,:... ❑ o
10
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
[::
"` Date of Inspection 11/10I97
Facility Number 31 284
Time of Inspection 1400 24 hr.(hh:mm)
13 Registered 0 Certified ®Applied for Permit 13 Permitted 113 Not Operational Date Last Operated:
Farm Name: County: D.UpIlix..........................................
,I�.rtwig,are.Nuxs��t�c....................................................................................... ..... .W..]fR. .........
OwnerName: A!Taity.Acrnigan................... HaAty........................................................:.: Phone No: 9.j9.2,9f ffl9.S............................................................................................
Facility Contact: Mairy..,Letaigau.Hm1y..................... Title: .Qwmr.................... ...... Phone No:
............ ........................ ...................................................
Mailing Address: M.Boa.82.3............................................................................................ Kenansville.AC............................................ Z83.49.............
Onsite Representative: Marry1cmitgan.Husty............................................................. Integrator:j_!' twpby.k:axWJy..k:ajr tars.......................................
Certified Operator:RiLi 1ph Y........................... Ha.YXy................................................. Operator Certification Number: .IQ646.............................
Location of Farm:
Latitude 35 • 02 00 Longitude 77 ' S3 10 u
Designurrct Design. Current Uestgn Current
Who_ Popula#'ron Poultry Capacity Poulatron Cattle Cpacrty Population
M Wean to Feeder 2600 2600 ❑Layer ❑Dairy
❑Feeder to Finish ❑Non-Layer ❑Non-Dairy
❑Farrow to Wean ... ...
❑Farrow to Feeder ❑Other '
❑] arrow to Finish Total Desi na0 act. 2 600
g .... ll.. ti}`A.
❑Gilts
❑Boars Total SSLW 78,000
Nttinber o,La noes Effiddin Ponds 1 ❑Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
:.......�...:..:.:......:..:..:;....:fi..:.::: .......;.
❑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 M No
Discharge originated at: ❑Lagoon ❑Spray Field JI Other
a. If discharge is observed,was the conveyance man-made? ❑ Yes ❑No
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) [] Yes ❑No
c. If discharge is observed,what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?(If yes,notify DWQ)
❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes M No
4. Were there any adverse impacts to the waters of the State other than from a:discharge? ❑ Yes ®No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑ Yes M No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect.at the.time of design? ❑ Yes M No
7. Did the facility fail to have a certified operator in responsible charge?'; ❑Yes ®No
7/25/97

Facility Number: 31-284
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes N No
Structures(Lagoons.Holding Ponds,Flush Pits,etc.)
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes N No
Structure 1 Structure 2 Structure 3,' : Structure 4 Structure 5 Structure 6
Identifier:
.................................... .................................... ................................... .................................... .................................... ....................................
Freeboard(ft): ..............1.,9Z............. ........ ............... ...................................
10. Is seepage observed from any of the structures? ❑Yes N No
. Is erosion,or any other threats to the integrity of any of the structures observed? ❑Yes N No
12. Do any of the structures need maintenance/improvement? ❑ Yes N 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 N No
Waste Application
14. Is there physical evidence of over application? ❑Yes ®No
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
15. Crop type ....................... .......................................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? N Yes n No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes N No
18. Does the receiving crop need improvement? ®Yes ❑No
19. Is there a lack of available waste application equipment? ❑Yes N No
20. Does facility require a follow-up visit by same agency? ❑Yes N No
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑Yes N No
22. Does record keeping need improvement? N 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 N No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes N No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes N No
O'No irloIati6'n'8.or-dcrkI:enFieS:Vvere.notedvurinLK ithiS•v;sit.:Wig.Wd1'rbCe1Ve V)Urt�her•-
.correspondence Aoiti ihis.visit•.-. : . .. : . . .
Comptr n#s [titer#o{�u ton# l x lain ny' S t wCFtz an �vic auk r_iAntmcn+faDo"or any+atther v¢tnut�ts
ffse d3ruwan a of iacilE# to be to+esplat�sE€uatrabs us+�addI JOB page as ssne
OR done with Ms.Hasty.
16) Is currently having WUP revised for fescue and corn/wheat/soybean rotation.
18) Is planning on redrilling those areas of fescue that are sparse.
22) After receeving new WUP should balance N on records. Need waste sample within 60 days of irrigation.
Should have odor,insect,and mortality checklists added during VA JP revision.
7/25/97
ReviewerlInspector Name 44 Fi#zgecald
Reviewer/Inspector Signature: Date:

=z ❑DSWC Animal Feedlot Operation Revlew
ke
€ �DWQnlmal Feediot`Qperatzon Site Inspection
Q Routine 0 Complaint 0 Follow-up of DW inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Date of InspectionM
Time of Inspection24 hr.(hh:mm)
Total Time(in fraction of hours
Farm Status: ❑Registered ❑Applied for Permit (ex:1.25 for I hr 15 min)}Spent on Review
®Certified ❑Permitted or Inspection includes travel andprocessing)
❑Not Operational Date Last Operated: ...... ......
Farm Name: -�t 1 .s�..... .. __.... ._ _.. .. .._ ...... » .......
County: .. __.
Land Omer Name: .. A.-I-XI........... Phone]v'o:. .�..��. .9.►..` Q.� .. .... _.
Facility Conetact:...__ .._.................................. Title: ...... Phone No:
. r
Mailing Address: �.�: .���5, ....� ...�_ . .....�-�.
Onsite Representative: ...:.- ,.% .. Integrator:
Certified Operator: ... .._..... �....... a ............._......_....... . ..W... Operator Certification Number:1.1.6fi ...-..
Location of Farm:
-
r � . _....-L...a 1rs_i.-1.�.......
.�.tSS
1 Y
1�,-0 r...�'4,. r. _ ...1►n.. 5 .. •-t
.t 5�.1.3.D�?.._ ._.. ....._....._ .... �....__ ... . ... _ .. --------------- ...................-........_..... _...__ ..-._............._.... a
Latitude Longitude
Type of Operation and Design Capacity
�,
Design (:tirrent esign Careen# Design urgent
1?ouf , -4. Cattle
h.Ca aci Po ulation v_ Y Ca acity .P( ulation — Ca' aci wPo ulahon
Wean to Feeder f❑Layer___ ❑D
❑Feeder to Finish El Non-Lay er ❑Non-Dairy
Farrow to Wean ` '. �0. 22 <
Farrow to Feeder Total Design Capa6111 N
4
Farrow to Finish
. D
ft
❑Other t
U.
yA
NumbiZf Lagoons xoldtmg Pontlsr ❑Subsurface Drams Present
❑Lagoon Area::15110 Spray Field Area
Ge—neral
I. 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 E�No
b. If discharge is observed,did it reach Surface Water?(If yes,notify DWQ) ❑Yes JK No
c. If discharge is observed,what is the estimated flow in gallmin? 14
d. Does discharge bypass a lagoon system?(If yes,notify DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ❑Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes No
5. Does any part of the waste management system(other than lagoons/holding ponds)require ❑Yes ®No
4/30/97 maintenance/improvement? Continued on back

Facility Number: .. ——..U...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ,KNo
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes ®No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑Yes IN NO
Struct ores (Lagoons an or HoldingPonds)
9. Is storage capacity(freeboard plus storm storage)less than adequate? ❑Yes RNo
Freeboard(ft): Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Z
10. Is seepage observed from any of the structures? ❑Yes 91 No
11. Is erosion,or any other threats to the integrity of any of the structures observed? ❑Yes ®No
12. Do any of the structures need maintenance/improvement? ®Yes ❑No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑Yes ®No
Waste Application
14. Is there physical evidence of over application? ❑Yes CUNo
(If in excess of WMP,or runoff entering waters of the State,notify DWQ)
15. Crop type luSxnt_:Q........................rIfL............__. .......... �.... ..... � ..... ....,
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan(AWMP)? JR Yes ❑No
17. Does the facility have a lack of adequate acreage for land application? ❑Yes N No
18. Does the receiving crop need improvement? ❑Yes MfNo
19. Is there a lack of available waste application equipment? ❑Yes O"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 BNo
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑Yes ®No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes KNo
24. Does record keeping need improvement? ❑Yes ®No
/Carments(refe 'tqest�o � monro n dn s nr any othr er comments
Use drawmgs=of,facility to better explain situatfons:: se.(u additional pages as necessary)
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Reviewer/Inspector Name -" `, .. Ia d IN.
Reviewer/Inspector Signature: - Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97