310370_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qual

Date of Visit: 7r /% %� Arrival Time:Departure Time: l6z> 1 County: Region: jrr
Farm Name: y /
Owner Name: <�G/' % ( 2�
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: �V4 R4-*zq1_Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: (%Q
Certification Number:
Longitude:
III
Swine
Wean to Finish
IIIIIIIIIIIIII Design Current
Capacity Pap. Wet Poultry
La er
Design Current
Capacity Pop.
Design C*urrent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Dairy Calf
F eder to Finish
DairyHeifer
arrow to Wean
17�
D , P,oult .
Layers
Design Current
Ca aci P,o ..
D Cow
Farrow to Feeder
Farrow to Finish
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
ow
Other
Other
s
Turkey Poults
Other
Discharees and Stream Impacts
I. 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
61K*o ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
-40
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
v ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
I_✓J No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

IFacility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA. ❑ NE
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2iz
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 040, ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t at, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ��Z�oNA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ 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
hlo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
��eo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
l 149
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
Eto<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yesrr-o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ 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 RNA
udge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Vo ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ONo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZeNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
,Reviewer/Inspector Signature:
Page 3 of 3
le^ S
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes E ❑ NA
❑ Yes No ❑ NA
❑ Yes � ` o ❑ NA
❑ NE
❑ NE
❑ NE
Phone: ^'YG "' ZL /S
Date: A&I
21412015

Type of Visit: Q Com ance 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: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
i
Facility Contact:
/ Title: Phone:
Onsite Representative: l —le ( & ka-11 rt
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Region:
Certification Number: /fin y
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry C**specify Pop. Cattle C*apacity Pop.
Finish La er Da' Cow
Feeder
Non -La er
Dai Calf
o Finish
t. o Wean OO
F
Dai Heifer
Z Design Current Cow
D. P■Quit , Ga aci P,o Non -Dairy
La ers Beef Stocker
o Feeder
o Finish
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other U
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes 0 No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes rNiN
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes [No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is sforage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No
Structure I Structure 2 Structure '3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1-3 ?
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E: o ❑ NA ❑ NE
❑ Yes E]No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes rNo
N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ej No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ej No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Wo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[� o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
.
21. s record keeping need improvement? If yes, check t appropriate box below.
D�Othe
Yes
❑ No
❑ NA
❑ NE
Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
r] 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
I! N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - fJ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2<0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No [�A `❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [2 1V o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes `; " o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ®-into ❑ NA ❑ NE
Comments (refer to question #):'Explain any YES answers and/or any additional recommendations or any other. comments.
Use dra*ings,°of facility to f;etter explain situations' (ase additional pagesasnecessary).
_
1/01C:�) .0 e—\ A e' 0 C4
Reviewer/Inspector Name: ✓� Q ( Phone:
Reviewer/Inspector Signature: PV j-Date: 2�L
Page 3 of 3 21412015

hype of V isit: tQ Com lance inspection U Uperation Keview V Structure Evaluation U I echnical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: L� County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Swine
Wean to Finish
Design
Capacity
C►urrent
Pap.
I
Design Current
Wet Poultry Capacity Pop.
ILayer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dry P,ouIt , Ca acit P,o
D Cow
Non-Dalry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
t]ther
Other
Turke s
Turkey Poutts
Other
Discharves 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 DNA ❑ 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)
2. is there evidence of a past discharge from any part df the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3
21412015 Continued

IFacility ISumber: - Date of Inspection: (o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes El"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): �{ z
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �Noo ❑ 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 ErNo ❑ 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 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
M No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
to
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0"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
Io
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6-No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Oth :
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes d1No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Ej No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

79
Facility Number: - Date of Inspection:
24 Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑❑ NA ❑ NE
25. the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes to ❑ NSA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No []'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes []'go— ❑ 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 o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes EfNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E31No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional, recommendations or any other comments.
Use drawings of facility.to better. explain situations (use additional pages as necessary).
i f �g11Jr0/ PS
S[4�1t
�cirV-f /j�
PEA �+r�� /�C-9r Is
(-,9p
2j9OL( z���, P��
�+ o ��d���,y�✓
lam' J
t
27 s�o /G
ice+"
ar`
Reviewer/lnspector Name:
✓ �
P
Phone: [phone] f`
Reviewer/Inspector Signature:
�-✓"
Date:
Page 3 of 3
21412015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: } f 1y Arrival Time: ®-^Departure Time: County:N
Farm Name: 1 g1 ZU �LAA)b A0Q Owner Email:
Owner Name: yZc(Z"� V�L�/� Phone:
Mailing Address: �c �7G7CK1AK5_ 1Ali—; 416 � a �L NC p, 1 � �1
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: K a 1 Thy w . 1 �:, LAN
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
) %may
Design Current
Swine Capacity Pvp. Wet Poultry
Wean to Finish I I Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean s(
Farrow to Feeder D . P,oul
Design
Dry Cow
Non-Dai
C•_a aci_
Pao
Farrow to Finish
Layers
Non -Layers
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
[:]Yes [:]No
❑ Yes No
❑ Yes No
[DNA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412014 Continued

Facility Number: -71 jDate of Inspection:
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ONE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 66cw
Spillway?:
Designed Freeboard (in): 1 , S
Observed Freeboard (in): �10
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes *No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s): ZeSL
13. Soil Type(s): (
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
ReAuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes XNo
❑ NA
❑ NE
the appropriate box.
Q WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes � No
❑ NA
❑ NE
0 Waste Application El Weekly Freeboard El Waste Analysis ❑ Soil Analysis
❑ Wste 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
21412014 Continued

FaciliNumber: 1 113ate of Inspection: [p
2A. Did the facility fail to calibrate waste application equipment as required by the pen -nit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
0
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
9
❑ 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 rile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
[] NA
❑ NE
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES :answers and/or any additlonal'recommendations or.any other comments.
.:
Use drawings of facility to better explain.situations (use additional pages as necessary).
I L V--r V,nz1 D+aD
3 ,DCE SL41uqF-�S� L/
Reviewer/inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
1— mlzw DA c Avve S Phone: 9/6 _IVi3 )
Date: Ial)17l19
21412014

Type of Visit: 40 Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: QjRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: � Arrival Time: Departure Time: County: r t n Region:
Farm Name:-�'�i� �j S 1 ,Y 1( ,� Owner Email:
T_
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: • y j Integrator:
Certified Operator: I�"eJ �1 Certification Number: �3
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design C*urrent
Wet Poultry Capacity Pop.
I ILayer
Design Current
Cattle C►►opacity Pop.
Dai Cow
Wean to Feeder
Non -La er
I
airy Calf
Feeder to Finish
ent
Dr. Plouit, Ca aci Plo
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
N465
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharizes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes J?fNo ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes iio ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Wo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

[Facility Number: jDate of Inspection:Mks
I
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?
❑ Yes
[!:r No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J' No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
;a 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
ETNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[::]Yes
PrNo
❑ 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 4No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes eNo ❑ 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 D 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 Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes PNo ❑ 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 ,VTNo; ❑ NA ❑ NE
Required Records & Documents if
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 rNo ❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E!J"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page, 2 of 3 21412011 Continued

Fa cifity Number: - Date of In ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 01 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ffNo ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ?I No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
eNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�No
❑ NA ❑ NE
m and report mortality rates that were higher than noral?
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
V] 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
4No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
1,2rNo
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:����
Date:
21412011

�1 0t©
Type of Visit: S3,Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: lRoutine O Complaint O Follow-up C) Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �6_rr)4
Inte rator:
Certified Operator: v
� [—��'TN
Yy _
C.R_Nt�
Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swiue Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean Op
Farrow to Feeder
Design Current
D , P,oul Ca aci P,o ,
Cow
Non -Dairy
Farrow to Finish
Lavers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Ej
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes )kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ko ❑ NA ❑ NE
Yeso ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facilir umber: - (� Date of Ins ection: D /
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
4
Identifier: LAGOC11 V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 1XNo
❑ 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
1�����."```
❑ Yes Ix E 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 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �] No ❑ NA ❑ NE
maintenance or improvement? 0
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et�.,)
❑ PAN ❑ PAN > 10% or 10 lbs.
❑ Outside of Acceptable Crop Window
12. Crop Type(s):
❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
Q Evidence of Wind Drift ❑ Application Outside of Approved Area
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA [] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists ❑Design M Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )A No ❑ NA ❑ NE
Q Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ V'Tldste Transfers ❑ Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections 0 Monthly and V Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeili .Member: -3 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes XNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
[] Yes 0.
No
❑ Yes �No
❑ Yes KkNo
❑ Yes JXNo
❑ Yes DkNo
❑ Yes �allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional;recommendations.or any, other comments.
Use drawines of facility to better explain situations (use additional pages as necessary).
lJ3 a [+ k
qq
05
Dols
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: ! )o -�q(o �
Date: 10116 La
214,12011

Type of Visit: compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: )LRoutine 0 Complaint O follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: j {Arrival Time: Departure Time: /O'{ County:ht,,(�U/� Region:
Farm Name:1'iCYI9[�1� Owner Email "`�'
Owner Name: Phone:
Mailing Address: It 94 S Tocr y �Ac SC- " -L A C
Physical Address:
Facility Contact:
Title:
Onsite Representative: 1-[ l T-1 `I-C.aX/
Certified Operator: —&I T14- U— • iILA N
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Cer i� 6cati }n Number:
Certification Number:
Longitude:
DesignIKKOurrent
Swine Capacity
Wean to Finish
Design u
Pop. Wet Poultry Capacity Pop.
La er
i 111111RQDYV9fign
Cattle
Da' Cow
Current
city Pop.
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean pb
Farrow to Feeder
Farrow to Finish
Design C*urrenY
Dr, P,opIYG CaPAC P,o
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
er
Turke s
urke Pouits
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes PN
o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:)Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
NA
❑ NE
Yesozo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: 2z I - Date of Ins ection:
Waste Collection & Treatment
4. Ig-siorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �kNo ❑ 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: (A(� cJ
Spillway?:
Designed Freeboard (in): , 5
Observed Freeboard (in): L1I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
�k
❑ 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
L No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,,, ,,,
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidencce' of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): V � 1� G) 5
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists Q Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. )91 Yes ❑ No
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections r ❑ Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ( No
❑ NA ❑ NE
❑ Weather Code
0 Sludge Survey
[] NA ❑ NE
DNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3 - —1 Date of Inspection: L l
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Ys the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j No ❑ NA ❑ NE
the appropriate boxes) 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 _t� No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[:]No
'0�`NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
-
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
j*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)
'C
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
JkNo
❑ 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] No ❑ NA 0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [—]Yes 6&No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes #_No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments ; x,
Use drawings of facility to better explain situations (use additional pages as necessary)::-
�. N s► s � �� QE a41c--Al [y(�OV-E cAz-
C o
U UEQ-
N(j
-r 1�T�iS ��siU4i J��RouE fJF.�XT
(t150lL SIA,KQc
l.T `p`z.G 1 ' 1 S "An c strtrc_u
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Division of Soil and Water Conservation
0 ofWater E uahty `
Facihty'Number �U
ncy
Othe e
Type of Visit XCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: C 1 Al Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: !�F �TEi �� ' ��-� Opera` for CeOrtification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = & Longitude: [� ° [= i
tYa a
Design; , Cnrrent a k ^ Design "Current " `' x, Design ` Y Current
Swine
p ty wp Wet Poultey p ity p Cattle` p ty per,
Ca aci Po ulation Ca aci Po Mahon Ca aei Po Mahon .
uy ❑Wean to Finish
La er
P[0—
❑ Dai Cow
❑ Wean to Feeder
Non -Layer
❑ Dairy Calf
❑Feeder to Finish,
�;;�" �41 �,
❑ Dai Heifer
' Farrow to Wean
t-i """*
I)ry�l?gultry
El Dry Cow
❑ Farrow to Feeder
. ,
ElNon-Dairy
ElFarrow to Finish
ElLayers
❑ Beef Stocker
:= ❑Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
�] Pullets "'
❑ Beef Brood Co
❑Turke s
Other _� `.� ❑ Turkey Poults
❑ Other
❑Other
Numher; of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ 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
o
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes *o
[INA
ElNE
a. If yes, is waste level into the structural freeboard?
[IYes [I No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �-4YJ1g
Spillway?:
Designed Freeboard (in): +Q ..S
Observed Freeboard (in): 3H
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
[INA
ElNE
(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
A No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
J Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
%
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Window El Evidence off Wind Drift
❑ Application Outside of Area
12.
�Crop
Crop type(s)
13.
Soil type(s)!—I
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16_
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[(No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
IXNo ❑ NA
❑ NE
Comments (refer to questron #) Explain any YES'' swers and/or any recommendations or�any othe rcomments
Use drawings of�facility to better explain situations (use additional pagipTas necessary) s „
i
T
Reviewer/Inspector Name
� �x+
�. � E :� .. _ �� t. „r �, Phone: 9
;._� _,
Reviewer/Inspector Signature:
Date: /6
Page 2 of 3 12128104 Continued

Pi.
q.
Faellity..N�mber: 31 -3�0 Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropriate box. 0 W'Up 0 Checklists ❑ Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Xyes ❑ No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard N Waste Analysis 0 Soil Analysis ❑ V/aste Transfers ❑/nnual Certification
0 Rainfall 0 Stocking 0 Crop Yield El 120 Minute Inspections 0 Monthly and I " Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑{ NA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
/J
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
111
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes]
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
I
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VrNo
❑ NA
❑ NE
.andlor Drawings:
A ihona omments
9Ja�l�o �.3
N,5��
� 7a Sa �'c+i< 1--"00,1 To IUE
FTI�K-
. �I'T (rc�-�`�T 'i a G, GT � N � `�O Sal � SA �P�� 12-�u�s ► r p � s� 5� l�
GAc-►Qclz► ►cam/
UCN i
�clF i To( 14s AP
Page 3 of 3 12128104

�k.
rl
Type of Visit R Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ®Departure Time: County: Region:
Farm Name: C) 1 �X'� ��Q� Owner Email: n
Owner Name: ,�-L 12�_ _ LPA o Phone: 9 1&DR9-�1 �X'7 ',1421
Mailing Address: � � T cc- V.CSk—= Of LL- � / ►� OrU�-! J �
Physical Address:
Facility Contact: Title:
Onsite Representative: , KE) rN _RC.A Nb
Certified Operator: e rTH w • Q-gwb
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: `OW L/
Back-up Certification Number:
Latitude: 0 0 [ =" Longitude: [� ° = 4 [= ,1
Design Current Design Current Design Current
Swine Fapacity Population Wet Poultry C*opacity Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Feeder to Finish
pry Poultry
❑ Layers
Farrow to Wean 60
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Layers
❑ Gilts
ElPullets
❑ Turke s
❑Turkey Poults
❑ Other
❑ Boars
Other
❑ Other
Discharees & Stream impacts
1. is any discharge observed from any part of the operation?
❑ Yes
0 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
No
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

I
_1 .
Facility Number: 3 1 —3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes k No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ANo ❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ YcsXNNo
❑ 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 ofAcceptable Window ElEvidence of Wind Drift [IApplication Outside of Area
12.
Crop type(s)
lCrop
& q bl17 1'�
13.
Soil type(s) �-� A
_
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[ No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes (ANo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes kNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any'recommendatiuns
Use drawings of facility to better explain situations (use. additional pages as necessary)
Foe-w€CiJS )A/ sou tJ SG T FIEF-�
IReviewer/Inspector Name I f}J " .` :I Phone: — mfll1�"
Reviewer/Inspector Signature: y"41M . c., Date: C
12128104 Continued

Facility Number: 3 f 3 Date of Inspection RUNJ.01
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
B WUP El Checklists ❑Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑$ante Transfers ❑/OfInnual Certification
0 Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections El Monthly and 1" Rain Inspections El Weather Code
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes XNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes A No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes NNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
ElNA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
ElYes 9No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No XNA [INE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �(No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
ElNE
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
9No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
%No
❑ NA
❑ NE
w.A-
31.Q-4-109 I "+'
Uj1&1Qq 1
a I. G E � c¢op
�c-�� uyhA i �� ��� 10
G AWGS
910-Sso-may
12/2&/04

Division of Water Quality
Division of Soil and Water Conservation
%
V
Facility Number
0 Other Agency
Type of Visit Xcompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for VisitRoutine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: L I/v Region:
Farm Name:
Owner Email:
`1 Owner Name: ogezT LU__ _w Phone:
Mailing Address:
Physical Address:
Facility Contact: 2 Title:
Onsite Representative: KG — I TH '}t-�
Certified Operator: tE ITO L �`�
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: ! 21n�H
Back-up Certification Number:
Location of Farm: Latitude: � o E:]'E Longitude: [:::] o
w
r Design Current' Design., Current Design Current
Swine" " Capacity -Population Wef`Poit�try Capacity Population Cattle Capacity:` Population
❑ Wean to Finish ❑ La er
`' ❑ Wean to Feeder ❑ Non -Layer EEE1
ElFeeder to Finish
Farrow to Wean OG Dry.Poultry
❑ Farrow to Feeder
Y
ElFarrow to Finish
ElGilts
❑ Boars
Other
❑ Other
❑ Layers
ElNon-La ers
ElPullets
ElTurkeys
❑ Turkey Poults
ElOther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
ElBeef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
j
Number of Structures:: n
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes , k No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ N>✓
❑ Yes ❑ Na
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes �No
❑ NA
❑ NE
❑ Yes *o
❑ NA
❑ NE
I2/28/04 Continued

Facility Npmber: _ Date of Inspection _d I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes XNo
❑ 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: LiKocW
Spillway?:
Designed Freeboard (in):
?S
Observed Freeboard (in): �7 J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 19 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes KNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 14 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes VNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes M,No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ANo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes KNo
❑ 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
4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,q No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IVNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ 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):
0?1. Ge-rr o F AuC AWNUAL-S r 0c-r-1/U6, 1+
L V RICE% s t E �%
Q �
aS. C or r� x F>M1 wr FCWz s LuOG c suc�� � y oA- c 6 +? �E ;-E A S c.&7c E
uGLu Fo4_E ENS of to w
Reviewer/inspector Name 12DR C' fajaFS I Phone:
ReviewerlInspector Signature: '�.� , qWn� Date:/Z Ld
Page 2 of 3 12128104 Continued

acil"ify'Number: �j 3 Date of Inspection O 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IxNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Designs ❑ Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ElStocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
10No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
FNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2No
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
\ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,K,'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
KNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
El
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
[I 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
jj`No
❑ NA
[3 NE
General Permit? (ie/ discharge, freeboard problems, over application)
``
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

N,
t �46 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: E4V0 Arrival Time: 1) Departure Time: County: &PL.T&I Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: ke:rrl1 _ 9-LAND - Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 6 0 « Longitude: 0 °
Design Current` Design Current Design -. .Current- '.
Swine. Capacity' Population Wet Poultry .' Capacity Population. Cattle Capacity Paputaitou r.,
❑ Wean to Finish T
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other - - - - -
❑ Layer
❑ Non -Layer
Dry Poultry
Non-L;
Pullets
Other
Poults
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑Yes ❑No
El NA
❑NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ o
❑ Yes 2
❑ NA
❑ NE
❑ Yes YNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — 7U
Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier:+ &Zyp)
Spillway?: c
Designed Freeboard (in):
Observed Freeboard (in): 3 y
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes RI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ElNE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thhr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes W140
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 4. Does any part of the waste management system other than the waste structures require El0 Yes 0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E5No ❑ 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 El Application Outside of Area
12. Crop type(s) 17L 4, S {� Q
13. Soil type(s) C 04
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [!(No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes B No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes FerZo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ld ❑ 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):
SRO 1V&AT4P ("F ' _ne_s , N4 s-r6 PVA L1-J r_F, A.t1O SToc/In16 Td DWQ nZ7j1z►1 19
�-sJ S�Nh GoP� of RC(,GNT sCd► C6 ro Aw¢ k),r4rwx1 Wf.
CAt,r ZA7'znA1 /I�EEDC-d Qy 4 cT, 1 dJjV( DM* qa,2 ft*�Ifi rN- Z& .4D4
Reviewer/Inspector Name jdlV V rA�� ( ( L ` Phone: 9/D iy(, —7300
Reviewer/Inspector Signature: Date: 1011 7 b 6
rage z Of 3 1141Loav4 a.vrni,.ucu

f
Facility Number: Date of Inspection 7
Required
Records & Documents
/
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
El Yes
N
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, chec the appropriate box below.
LJ Yes
❑ No
❑ NA
❑ NE
El Waste Application El Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ dtocking 1 ❑
Rainfall crrop Yield 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections
Weather
Code
22.
23.
Did the facility fail to install and maintain a rain gauge?
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesVNo
❑ Yes
❑ NA
❑ NA
❑ NE
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
LLJ YY s
El No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
L"J Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
![J No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ZA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
2 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
P 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
,.,,�
E No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P'<o
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

10
iType of Visit (2JCom Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance
ReasonforVisit QZ01 tine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1100 Departure Time: County: ()IlP L :2 N/ - Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: K-E?7N - ouoo Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification: Number:
Back-up Certification Number:
Latitude: = o = 6 Longitude: 0 ° ❑ 1 =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean Zul
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other IJ
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ❑,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[:1 NE
El NA
El NE
❑ Yes
El No
El Yes
E] No
❑ NA
❑ NE
❑ Yes
[?,�e•❑ NA
❑ NE
12128104 Continued

Fi eility Number: 31 — 3 %
Date of Inspection
Waste Collection & Treatment
�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
in 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: LA 6o--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L1 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 thre
t, 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 L 'Wo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) //
9. Does any part of the waste management system other than the waste structures require El��
Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 10 ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive -Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) Ze4z_s,&upA L 4 ) S %-0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes
Ia No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
K
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN
❑ NA
❑ NE
iq. j l&EP AOD ?e0-mlir wsrA
a !) UPDATE CRoP ��c_l.p . � C s t, g=rc -� � G i rAo R fA `� � � m
gGbf, chi'
rA p_,AA- Uoo j<g Go Q
Reviewer/Inspector Name `] 6 RlU +~LV '` Phone: /� 7 ,6 a
i.
Reviewer/Inspector Signature: Date: a S`
i�i�aivg �.a�rnnueu

•Fdtility Number: 3 1 — Date of Inspection j^ o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design Maps Other
21. Does record keeping need improvement? If yes, the t e appropriate box below. IJ Yes ❑ No ❑ NA ❑ NE
❑ Waste Applicat' n ❑ We y Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall Stockin Cro Yield ❑ 120 Minute Inspections El Monthly and 1" Rain Inspections ❑Weather Code
g p
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E 1 O ElNA ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes LI'No El NA ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ElYes El0 No A ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [] No PNA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes L'No ❑l NA El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes ❑ No El NA ❑ NE
Other Issues
Yes ❑ No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
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
dNo
❑ 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
CTNo
❑ 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
�,/
L� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA
Zo/
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
❑ NA
❑ NE
Additional C6mments.and/or Drawings:
12128104

Date of Visit: 16 1 - o+j Tune: pd
acility Number � 37d
O Not Operational O Below Threshold
Permitted (" Certified [3 Condidona'Dy Certified [3Registered Date Last Operated. or Above Threshold: -------- ......
Farm Name: ..... & Q 9,Y _ R LA ND . N d is rAR'iv` - ---- County: ........NJ PL,10...._......................................
Owner Name:
Phone No:
MailingAddress:..................................._....................................................................................................................... .... ........................
Facilitv Contact:
Title:
Phone No:
Onsite Representative: ..... ... V .r___L 4 ..... Integrator: .��... CA KA °?A,' S
Certified Operator: .............. . .... . . . .......................... _. ..._ ..........._... Operator Certification Number:... ._ ........... _.._.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 06 " Longitude • 4 44
Discharges & Stream Impa cgs
1. Is any discharge observed from any part of the operation? ❑ Yes '[I/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/inin?
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 MVo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑'Ro
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............ ...I................... .... .................... ..� �� .. ............_- - - - -�_. _ `__.--•••--..,..�...-.�....
Freeboard (inches): 36
12112103 Continued

Facility Number: 31 — G Date of Inspection /6 )
5. Aie there any immediate threats to the integrity of any of the structures obs�erv^ed-??(ie// trees, severe erosion, ❑ Yes eNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes �To
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public Stealth or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [21�0
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Bl�oo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Bl
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes Dq4
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes io
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Q C tt.InndtiC-A ( u 4 G ) Ss"4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [39oo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ iQO
b) Does the facility need a wettable acre determination? ❑ Yes [� Z
c) 'This facility is pended for a wettable acre determination? ❑ Yes L�'
15. Does the receiving crop need improvement? ❑ Yes �0-
16. Is there a lack of adequate waste application equipment? ❑ Yes io
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below • ❑ yes 01(o
liquid level of lagoon or storage pond with no agitation? ,�
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0-ffo
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
Air Quality representative immediately.
�ommeaets (rc er io question'- .) slam ai y YFS answers andloraay Ira �
_ _
LTae (u
to better exgtam szbpaitia�s. se additional pates as 'k ❑ F Copy mal Notes geld F
$�'
GC"-)TErL PaCV bT covic sz-A G
U�'�Ta"1'L✓ MAP 'Fa 0�-� � .
�EN0 m.,J Fates- O�W 96: ti-wk=r. r A4,X QU&STZ CM S caw Sro 19 s- 31aa
LL'a-?J+3)
Reviewer/inspector Name
ReviewedInspector Signature• Dane: lb l
l2/l2/03 1 Condnued

Facility Number: '!j —37,61 Date of Inspection
RSguired Records & DocumentK
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oet discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
29. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP7
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 0<0
❑ Yes To
❑ Yes
❑ Yes
B11100
El Yes
L7 O-
❑ Yes
i�o
El yes
C�'No
❑ Yes
of4/
❑ Yes
[ o
❑ Yes [9No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 9 Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
77-1
F_ Facility Number I If Date of Visit:7EN,t
Time: 3
O erational 0 Below Threshold
O Permitted O Ceerrtti�fied M Co ovally Certif d ©i3egistered Date Last Operated or Above Threshold:
Farm Name: `E-� L fff�� (�` County: ice! �iPL y/✓
Owner Name: �D.QiEfl� 44f'JO Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
�j J
Onsite Representative: T1 ;e,,if� 44,VQ integrator:e4?jOna-_5
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & 0" Longitude 0 1
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Discharges & Stream Impacts
Other
1. Is any discharge observed from any part of the operation? ❑ Yes 0No
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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes VrNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier: 1
Freeboard (inches):
05103101 Continued

Facility Number: —Q 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 ZNo
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 Fj No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XfNo
11. Is there evidence of over application?� P Excessive Ponding� ❑ PAN [� Hydraulic Overlord ❑ Yes ONO
12. Crop type/7�flmll,OA I HRtf 1 ��ii? �F1 G /r` /11�z1✓ / Nv fW 5
13. Do the receiving crops differ with those designated in the Certified Animal Waste —Management Plan-KAWMP)?
❑ Yes
JZ] No
14,
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
16.
is there a lack of adequate waste application equipment?
❑ Yes
.0VNo
XNo
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?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
'KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
10Yes
❑ Yes
� o
2 t.
Did the facility fail to have a actively certified operator in charge?
El Yes
VNo
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
V.
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[�N0
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 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
COMMON- (refer to in y YES aa� wers: dlor any recommendations or any other comments.
Ilse drawings of fa=110UI.Eul'107
plain sihiations (use additional pages as necessary): Field Covv ❑ Final Notes
-
LE�},�y /�,D�4A1f1'71 44 FLF_l4S,E �q�vr �
�AV 64PJ7- (v` �
No F11D, d I- IL1F8-0 5 % 8,C e�G�rF',a
fur,
rCa ��7 L/�4600�';`? 5'r o n! SEa2L/
S,E✓Fi2AC � Cam PGzIN �f
e LP
Reviewer/Inspector Name
Reviewer/Inspector Signature.
Date: Z Z
05103101 Continued

,.n
. t
Facility Number: — Date of Inspection dZ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, aspbalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments and/or Drawings:
❑ Yes ❑ No
❑ Yes X.No
❑ Yes)1110
❑ Yes �No
El Yes ko
❑ Yes No
❑ Yes ❑ No
/ `�� // /� ,��!%nl ,Q �GF'D �uJ/7�D d %���a�►1 W �7.SG �1i/�P/�� —� Q�u�i�
71�e Aez5 &5A5,?l
�SAM' 4e.44eW7
ero? PGA
l) lde'Y,os /tI , 66 4PP+'7F-V 4JE;w '45
j l6e t/P,014716.a
/VF6 D Lz�� �� s�o AW 7-002-
05103101

of Visit ,O'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit fd'Aoutine O Complaint. O Follow up O Emergency Notification 'O Other 1 ❑ Denied Access
Facility Number 3 Date of Visit:
© Permitted Q Certified rr--© Conditionally [[Cjjertified [3 Registered
Farm Name:..........11..Ir'!.....C1a..�?r'^�........................
Owner Name: � ©� e
Time- `7=3;
Not Operational O Below Threshold
Date Last Operated or Above Threshold: ....... ...._.
County vo I n
..............................................._._....... --
PhoneNo: .......................... . ........ . . ... .... . ......... . .... ..__.._�:.
FacilityContact: ............................................................................... Title:................................................................ Phone No: ................... ............ .............
MailingAddress: .....................................................................................................................
Onsite Representative: �� 61 ........ Integaor�G
. ....................................................... I!r,s.............. ....'_.... .. _
Certified Operator:................................................................................................................ Operator Certification Number: .................... ........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' 94 Longitude • �u
Design : Current Design Current Swe -CCDa esaicgia
Care-
t
Capacity Po elation utrY Cii aci-.Po uladon- ., Po atian
❑ Wean to Feeder 10 Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy _
Farrow to Wean
Farrow to Feeder ❑Other
-•, Farrow to Finish
Total Desigp_Capacity .
Gilts
❑Boars TotahSSLW-.
Nnntber of Lagoons ❑ Subsurface Drains Present ❑ I.aguon Area ❑ Spray Field Area
Holding Ponds I Solid Traps. _ .. ,: ❑ No Liquid Waste Management System
Discbaraes & 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 ErNo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes gNo
c. If discharge is observed, what is the estimated flow in gat/min? 1.t�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes XNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes OM
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from•a discharge? ❑ Yes O:fqo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier: ......................................................................................
Freeboard (inches): S�
5100
❑ Spillway ❑ Yes )!(No
Structure 4 Structure 5 Structure 6
........................
Continued on back

Facility Nwnber:j r —3'] Date of Inspection Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 'O'No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes P'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 ,EfNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes'JZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes A!fNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
it. Is there evidence of over application? ❑ Excessive Ponn+ding ZrPAN ❑ Hydraulic Overload , yes ❑ No
12. Crop type &err' v d A ci ti-1 . 5 r+•t 4 i i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes_Jallo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ZNo
16. Is there a lack of adequate waste application equipment? ❑ Yes eNo
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes .0140
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) Reyes ❑ 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 ZNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes gNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ,EfNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Pilo
24. Does facility require a follow-up visit by same agency? ❑ Yes j2rNo
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑No
No viola igiis;ejr tigf�e�e�ci�s ire ptjCe �llKixig this;v;siti Yo>j� ivi�l rt iye ti t'ul'thtr
•curies �eace.abaultthis�isit*• -.-. ..-•-,-•-•-•- - -•---•
Comments (refer tx►'.queshoa #}•= Explartt any YES answers andfor. any_recommendahons or;any other comments.
Use dsaWthgs_of facility to better iwam sittia ons.'(use additional pages as necessary}
_. _ _ .. m _. _ _.
1� , M�.'�l G,�l sa7f h�' is- r� ���� c, �^'t�}i�• 40K we�cl�4e Ac-4657
i ��q�� ZaaZ . Need 4o 'IAve G%,e gg61& aC. done Ace
t�,/as-fe Plah Aid record[ Vear'd' 01G(?'Aj fa b4z done Ace"ord.11
t�. Need 46 17'P-✓e ,'"s'eC¢ Cor+-el) ee(&' C441011 oip a 0r4 041
/VJAV�k5r r)+c IeCtjj reardJ
Reviewer/Inspector Name �n y1e �✓ q l ' [ S r
Reviewer/Inspector Signature: Date: 2 %1 61 5/60

FaFility.Nymber. ,3~' j �7O Date of Inspection J) 21 d
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes "Emo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Eylhio
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 'ET140
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �0'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;;rNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional-Comments.are or' rawrngs:_
1C�• 1 A� ){'Ok R_- kEt2� ��eebo��di retards 1'rvtSeif,'
C orreo4l i ; f ,r' e j ,5 o r1 �eY�; gyp¢ rsa►,, Kec� n(4 (A6 f
`re o en �,-D( re Gp r�s _ Need fa � se a was -fie q +tor L -si.s
GAn4coi t:✓ i� �t ; n �O d � y �' eeF o � f f or, -Ae 3��K 2`J
4e, r—) cvi cf a �I ed v7uq r,eg4sJ' needs 4o recH l co lodedl 661o+cr
orr It, CAI �� � r Need 40 Cpun� 0610be,-
l! a Nover'►6e✓a
o-( b e -retw o(o1 . N,- GA 40 S ko w
1r 4e re,, S ►^'+� l I f� r ot; r . TW IZ `Z r S S �avt L ot
b�- ;� o{.�l��t�, ala > J � �' e yes e►'�a-� : �e ; �t� � �rt~�er�i s � i s � etc rc� � �
K K T ere t-v as of -/e\i, pc c�,kdj etie-rotApr1; CQ4, a►, 4ke
Of 4i-cF ��jt�� ct fe)tyGaliah 0" ��P Sr-LC11(
p O c4-e L t;-- - Z -0 0) . (�',,O,,-e-' timed s ¢a 6e sore i O
o 0'-✓ '�� , & y p
s wtq l� �y fit i•� t hoe 16, -Q 4 t�J ✓1 �� Al►'1 ,
No4e : J --ash r,-05 le, fe►vtove.(A
c"SIC �� C �t�GJn deS t�jt'1 s�Ot+�l S S'10� )OtJm tl
1 r ,+,\d
s�r�s 4"1 - \e �eG�nt C[t� Ct -sfo� VIP
eF T6 . OccA -fie 1igve do Gvw%.en4a-[,ot, ;'? �L,e Aen5rc�s a�
t-t, 15ret q I I fI -4-1v:Ft -to Ve r it
/VO-qP; T11 e iq eecl- Gl�0 Lt Vv) �'JO[,t�S 77 l eL900r) ss 1?eC4`�� 2�t
415o, - �'it? ''mil l 2 S A p p of r
5100

IJ
Facility Number 31 .37D Date of Visit: 11-21-2001 Time: 9:35
Not Operational Q Below Threshold
® Permitted ® Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: - _- ....._
Farm Name: ............... County: RwiA--•--•--•--...._..--------•-
llftbkx.�la>0.d�og.k'arm........................................-•--•--• WJRQ--•--•
Owner Name: 131ik!<r2--------------.-._ �1�>tli----------------------------- Phone No:Z949�----------------
Mailing Address:.7.fi.7..S1.QgkWg.Hr,&d.R9.a.d................................................................. Ru1:.1JIll.. G........................................................ 7.8.45A ..............
Facility Contact:....._.....•...............................................Title: ....................... Phone No:
..............................................................
Onsite Representative: K�ith�lattsl__-- Integrator:CurAU'.&Ew ls�lltlti---------------------•
Certified Operator: k dlh.................................. Bland ................................................. Operator Certification Number:18.Q04.............................
Location of Farm:
East of Register. On North side of SR 1141 approx. 0.5 mile East of SR 1955. 1&
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 52 25 Longitude 77 • 55 ° 21 "
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
2400
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
TotalDesign Capacity 2,400
Total SSLW 1,039,200
Number of Lagoons 1 ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ------------- ............. ........................... ---------- ............... ------_------------
Freeboard (inches): 56
ne in � m i

Facility Number: 31-370
Date of Inspection 11-21-2001
wntinuea
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? .
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application _
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ HydrauIic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
❑ Yes ®No
❑ Yes ®No
❑ Yes ®No
❑ Yes ® No
❑ Yes ®No
❑ Yes ®No
❑ Yes ® No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ® Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
® Yes []No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to:yuestion ffi'�Explamu�any-YES answers and/or any; recommendations or any other, comments -
Use drawmngs_of facility to_tietter ezplamn §ituatmons (use additional pages as necessary) O Field Copy ❑ Final Notes _ -
_
14. Mr. Bland says he is having a meeting for wettable acres in January 2002. Need to have wettable acres done and the waste plan and
ecord ]seeping needs to be done accordingly.
18. Need to have insect control, odor control, and mortality management checjlist in records.
19. I recommend that grower keep freeboard records himself. Currently relying on service person. Keep all past freeboard records. Need
o use a waste analysis dated within 60 days of application events on the IRR2's to calculate applied nutrients. Need to recalculate
October applications for this. Need to count October applications and November applications toward samll grain instead of Bermuda.
Need to show the 100 lb starting rate for small grain. IRR2's should be updated daily. Representative indicated it is generally done for th
ns ections.
Reviewer/Inspector Name Stone-waILMathis entered by Bette Rose,
Reviewer/Inspector Signature: Date:

05103101 Continued
Facility Number: Date of Inspection 11-21-2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ® Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional s ., omments an or,-
11. There was a few pounds overapplication during the first window of the split application on the small grain this year in October
2001. Grower needs to be sure to follow split application windows to cut off dates for small grain - 100 lb rate is in plan.
NOTE: Small grain needs to be removed by April 7.
NOTE: The lagoon design shows stop pump @48". Mr Bland says that the technical specialist indicated a stop pump of 56". Need to
have documentation in the records from the technical specialist to verify this.
NOTE: The area around house to lagoons is neatly kept. Also the spray fields appear neatly kept.

Facility Number 31 37D Date of Visit: 11-21-2001 Time: 9:35
Q Not Operational Q Below Threshold
® Permitted ® Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold____ __ __ __ __ __
Farm Name: DQbbx.BlajvdHQg.k'axm........................................................ County: D WjU--------------------------------.--. W1110......
Owner Name:l3t►herf------------------ Dud---------- ----------------- Phone No:
Mailing Address:..7...7.. I(t li1714g.11�Dd.1ZRDd................................................................. RQxMILM ......................................................... Z6.45A ..............
Facility Contact: ...........................................................Title:................................... Phone No:
Onsite Representative: l�elthlhAti---------------------------------------- Integrator:��rr9A'1`oflsi��In�.---------------------.
Certified Operator: K illL.W................................. Bl".d ................................................. Operator Certification Number: l&QQ4.............................
Location of Farm:
mast of Register. On North side of SR 1141 approx. 0.5 mile East of SR 1955.
T
®Swine []Poultry ❑Cattle ❑Horse Latitude 34 ' S2 25 Longitude 77 • 55 21 s.
Design Current
Swine Canacity Ponalation
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
2400
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I JEI Non -Dairy
❑ Other
Total Design Capacity 2,400
Total SSLW 1,039,200
Number of Lagoons 1 ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier1.-------------------------------------•--•-------------------------------...........................
Freeboard (inches): 56
neln�...

r
t
u.3iwivj
a.ununueu
Facility Number: 31-370 Date of Inspection 11-21-2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
N No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
N No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
N No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
N No
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14. a) Does the facility lack adequate acreage for land application?
N Yes
❑ No
b) Does the facility need'a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
N No
16. Is there a lack of adequate waste application equipment?
❑ Yes
N No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
N No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ V", checklists, design, maps, etc.)
N Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
N Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application)
❑ Yes
N No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
24. Does facility require a follow-up visit by same agency?
❑ Yes
N No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Corninents refer tad # -E lip la�n.an YES a� savers and/or � or:any othercomments:
i q_ _ _ y _
�stion grecommendations _
Use drawings of facilrt to better ex lain situations use additional a, es as necessary) ❑Field Co Final Notes a .W - _ -
PY
14. Mr. Bland says he is having a meeting for wettable acres in January 2002. Need to have wettable acres done and the waste plan and
A-
ecord keeping needs to be done accordingly.
18. Need to have insect control, odor control, and mortality management checjlist in records.
19. I recommend that grower keep freeboard records himself. Currently relying on service person. Keep all past freeboard records. Need
o use a waste analysis dated within 60 days of application events on the IRR2's to calculate applied nutrients. Need to recalculate
ctober applications for this. Need to count October applications and November applications toward samll grain instead of Bermuda.
eed to show the 100 lb starting rate for small grain. IRR2's should be updated daily. Representative indicated it is generally done for th
s ections.
Reviewer/Inspector Name 'Stonewall Mathis entered by Bette Rose
Reviewer/Inspector Signature: Date:

05103101 Continued
Facility Number: 31-370 Date of Inspection 11-21-Z001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ® Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
I'Additional- omments'and or_Jrawmas:
I L There was a few pounds overapplication during the first window of the split application on the small grain this year in October
001. Grower needs to be sure to follow split application windows to cut off dates for small grain - 100 lb rate is in plan.
NOTE: Small grain needs to be removed by April 7.
NOTE: The lagoon design shows stop pump @48". Mr Bland says that the technical specialist indicated a stop pump of 56". Need
ave documentation in the records from the technical specialist to verify this.
OTE: The area around house to lagoons is neatly kept. Also the spray fields appear neatly kept.

. '
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 374 Date of Visit: 11-21-ZilUl Time: 9:35
Not Operational O Below Threshold
® Permitted ® Certified p Conditionally Certified 0 Registered Date Last Operated or Above Threshold_ _ __
Farm Name: I1Qkkx.0Iamdkiog.fai:m........................................................ County: Uuift.................................... . IR......
Owner Name: Ikert------------------ �Lausi.------- --- ------------ -- Phone No:
Mailing Address: .?..%.StRlthlAg.I4�tiS�.4 S?4................................................................. ROS.C.BAI. NC . U.45$ ..............
Facility Contact: ........................................................... Title: ...................... Phone No:
...............................................................
Onsite Representative:Integrator:�aXr9al'�
Certified Operator: KCRIt.W................................ Mud ................................................. Operator Certification Number: 1#004.............................
Location of Farm:
East of Register. On North side of SR 1141 approx. 0.5 mile East of SR 1955.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 52 & 25 a Longitude 77 • 55 & 2164
Design Current
Swine Canacity Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
2400
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design- Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer Dairy
❑ Non -Layer �JEI
Non-Dairy
❑ Other
Total Design Capacity 2,400
Total SSLW 1,039,200
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps JE3 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:--.--.--.--.1..
Freeboard (inches): 56
nein� "^I

vaiwiu�
Facility Number: 31-374
Date of Inspection 11-21-2441
"nunuea
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid Ievel
elevation markings?
Waste „Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes to No
14. a) Does the facility lack adequate acreage for land application? N Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes N No
❑ Yes N No
❑ Yes N No
N Yes ❑ No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) Explarnany YES answers and/or any recoitimendatrons or -any other comments:`
_
Use drawings of facility t9�betterexplain,situatibns (use additional pages as necessary) -- 0 Field Copy ❑Final Notes
- - =` -= W
14. Mr. Bland says he is having a meeting for wettable acres in January 2002. Need to have wettable acres done and the waste plan and
ecord keeping needs to be done accordingly.
18. Need to have insect control, odor control, and mortality management checjlist in records.
19. I recommend that grower keep freeboard records himself. Currently relying on service person. Keep all past freeboard records. Need
o use a waste analysis dated within 60 days of application events on the IRR2's to calculate applied nutrients. Need to recalculate
October applications for this. Need to count October applications and November applications toward samll grain instead of Bermuda.
eed to show the 100 lb starting rate for small grain. IRR2's should be updated daily. Representative indicated it is generally done for th
ections.
T
Reviewer/Inspector Name StonewallMathis entered by llitte Rose-
Reviewer/Inspector Signature: Date:

e A
05103101 Continued
Facility Number: 31-370 1 Date of inspection 11-21-2001
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 ® No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate. cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional- Comments and/or --Drawings: = -
11. There was a few pounds overapplication during the first window of the split application on the small grain this year in October A-
2001. Grower needs to be sure to follow split application windows to cut off dates for small grain - 100 lb rate is in plan.
NOTE: Small grain needs to be removed by April 7.
NOTE: The lagoon design shows stop pump @48". Mr Bland says that the technical specialist indicated a stop pump of 56". Need to
have documentation in the records from the technical specialist to verify this.
NOTE: The area around house to lagoons is neatly kept. Also the spray fields appear neatly kept.

Divtsioa of Soil and Water Conservation .Operahon3Review
Division af.Soti and yWater�Canservat<on'-.Compliance Inspection F= ' "
Y
T� IhvisiQn of Water (jaalIty -Compliance uspechon X7� G
a . z ©ther'A enc " Opei8tlOn'ReV1ew 1 r ssa' e �
Q_
JoRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3) Q Date of Inspection 'J 2 DO
Time of Inspection Q 124 hr. (hh:mm)
U Permitted © Certified ❑ Conditionally Certified 0 Registered Not O erational Date Last Operated:
Farm Name: 7 �..1. '��.. Q IG ate, County: ''. �........................................ .......................
t .....
Owner Name:'. ? p r`� I q,' NA Phone No:...,,,,,,,,,,
Facility Contact:.............................................................................. Title Phone No:
MailingAddress: .............................................................:....................................................................................................... ......j...................I............. ..........................
Onsite Representative: abb..lfn................................... l+d�T���IIJPx�ntegrator: Get f►' 4.!..L�.......................................................
........... J
Certified Operator:,...,,,
Location of Farm:
............................................................. Operator Certification Number:
A
.......................................... .............I...... I....................................................................................................................
Latitude ' C " Longitude • 4 «
Design Current
Swine -Capacity `'Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design - Current = - Design;_ Current
Poultry Capacity' Population Cattle,--- Capacity'=Po` ulaboh`
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other --
Total Design Capaci y4_:
Total=SSLW
- Numberof Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? $.Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard(inches): ..........33 ........................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facilit3:Number. ?I — 3 7U Date of Inspection 1242241 00
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there'a lack of adequate waste application equipment?
❑ Yes
❑ No
Reuuired Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. 'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) .
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a 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
ONo
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
O V1Q1i1QI15,0I' [��f C1eIfC'�CS H T....
AQt.E'� [1or.illg ti1S V1Slt. iOlTt W]i sec IVe ill) u�'t1l�i' _
corres oridence about this :visit:
S�,s yieG o�, Ca+�d u c cd )v, response 4a re O'r'Fur /4 JJrg4e.y-
►�I 101 v;4t.M47 dc
o y ))S f� 11 q I �O V"O W e,, O(Yo vP vp 'q ►-�a( ad v ; set m e 4 Aq he
ve✓G'ol -�l,q }- A G�rJCL,ye �rn oGclu�red a4 17;r
red c)e I/Y)e $'Al
�1ist}vl GLr�q��
r�✓>dl 'tea ked t,�c�S `B- C JA5-4e eA o Sctrved
�s-►S�rvc�e/ 6t06 d;4tk �b `1he� ;G�.Jlrtfa5.4-
�e tiov'-\ ped O di-FGk. �e'' RUq (coy+-})
Reviewer/Inspector Name =' - _ r c _}
Reviewer/Inspector Signature _ Date: rJ 2z/ OD

Fa,.tA'jy Number: -?I Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
-AdditionaM-onmnents an or .swings=.� :: z ._%_ = = ..
/'
of cs 1.� e rC �Gi 1�c�1 �, sG401--q o-r �q wi ,a � tvz-X'1 e 40 Su/'1rzGe
`
bc 9"'Cg4clJ4h.�h l000
q yaress �Iease .S�oulo�, GG �sS t,ed gCGOr�{;ryl �..

u nvision or aou ann'.watera%.onservauon -_i
rq. - ,.�. ,-.
b , [ Drvisron of Soil and. Water Conservation =
` ion of Water Qaanty -Compliance Ias
Agency 0,
tion-"ReViewf.e
Routine 0 Complaint 0 FoHow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 3 +7 Date of Inspection 1 — 0,0
Time of Inspection : oo 24 hr. (hh:mm)
'( Permitted © Certified [3 Conditionally Certified E3 Registered JE3 Not O erational a Last Operated:
b�rJl tJ l0.Y`O� ;ow Count �l Farm Name: ....... ................................................................ Y.. �.......
Owner Name:........1.t.�11.f l,?�..! `+P't.... Phone No:
Facility Contact. .._W.A Title:..... W.h tl?.........................1...... Phone No:
Mailing Address: ......................................................./D�....................................
......... i ........................................................................................................................... ..........................
Onsite Representative:....k�:�..:�..hl ... Integrator:....... Cj/]�fJ................................................ ..............................
Certified Operator: .............t. ....................... .. 1 ........................... Operator Certification Number: ........ ..................... 6............
Location of Farm:
Latitude 0 6 0�4 Longitude 0 6 46
F 'Current -
Design Current Design
gn Current - Design _ Current
Swine Capacity Po' ulation Poultry Capacity Po ulation = Cattle Ca aci 1'0' !llabon
- , ❑Wean to Feeder
❑ Layer ElDairy
[]Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other-
❑ Farrow to Finish Total Design. Capacity`
❑Gilts
❑ Boars :Total SSLW
Number of Lagoons d ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area ?
Holding Ponds /.Solid Traps ❑ No Liquid Waste Management System
Discharizes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage, capacity (freeboard plus storm storage) less than adequate? [ISpillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): r,-? �
❑ Yes �(No
❑ Yes ❑ No
❑ Yes ❑ No
4/P
.
❑ Yes
❑ No
❑ Yes
tkNo
❑ Yes
9No
❑ Yes 1� No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3123/99
❑ Yes [(No
Continued on back

Facility >;umber: ?�.11 — _3" D Date of Inspection 1 Printed on: 7/21/2000
►--
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ANo
(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 PR
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Pq No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ANo
I 1 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes XNo
12. Crop type [S R (,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? El Yes kNo
b) Does the facility need a wettable acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? ❑ Yes 5(No
15. Does the receiving crop need improvement? XYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ;KNo
RegLuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes f [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 ANo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'! ❑ Yes ,XNo
24. Does facility require a follow-up visit by same agency? Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes VNo
K' 6-yiiolaf 6tis or deficiencies were noted• 0&fng �bjs:visit; • Y:oii :will •i-eeeiye fio: Mirth&
... .. ......................
correspondence ah"f th' isit. .. ...................... • .
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- �j atP �� �.. w Sys r A- koS k6 ks Z-� I' r-
���� �OD4 ±K�4w
�'.l```--s t.BW 4vOOY1 [' tn� #-(, — 3 b 5 U p 1 f r v� s jv 1 i 500
�C.�-• PI_ P.r ur{-<GH,L� r&-VKJ tVd- )_ 4-UJU A ) A4 - a4'14,eldc
Reviewer/Inspector Name Z;. 4f -e •C Y Ine Y i SIG, r
Reviewer/Inspector Signature: <;�;
Date:
5100

Facilit},,Nomber: — Date of Inspection d� 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 Atlor 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 [kNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �j 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 kNo
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 permanenUtemporary cover? ❑ Yes No
Additional Comments and/orDrawings:
A.
V;
d
t-d 4-o tvan4—
�V-YI�I,T
G w a
w
5/00

❑ Division of Soil and Water Conservation 13 Other Agency
Division of Water Quality
1211outine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 3 Time of Inspection E=E124 hr. (hh:mm)
Registered 10 Certified 0 Applied for Permit .3 Permitted 0 Not Operational 1 Date Last Operated:
Farm Name ....B1f2mri..n .... .... County. �cl�in..................
OwnerDame r ............ ........................I................I....... Phone No:... `� l o 1 ..'1� b.............................................
Facility Contact: ............................ ........... . Title:..................... ...... Phone No:
Mailing Address: ..........
r/i!►...j`1 P-jtu)..................................................... ....... .z�Q........ L.i.�/.. j..R�`................................ ..S?5........
OnsiteRepresentative: .............Kim ........ Rl�Cl...................................................... Integrator: ......... 5.rtnYwu....... I................................................
Certified Operator: .................................................. ...- ........................................................ Operator Certification Number ........................
Location of Farm:
......Qra...... �.-► u...il...I.Ana......s.id......}...a.��.rr�i.la,s.......eac ....a ..SSA........Ms t.................................................................................... A
---- -- .------------------------------------------------------- .. . ........ .. .. ..... .
Latitude 0• 09 46 Longitude • ° "
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
[A No
c. If discharge is observed, what is the estimated flow in gal/min?
N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
qNo
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
R No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
VANo
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
"'Q No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
qNo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
R No
7125/97

t.Facill't,x Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Ilolding Ponds, Flush Pits, etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes 1�9 No
❑ Yes Od No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):•--•............I.........................................
10. Is seepage observed from any of the structures? ❑ Yes
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. p 6wh.q .:......Am 1.1A 41.41.........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ No.violitions-ok deficiencies:were-noted during this" visit.- Y_ ou:will recei�e•no�ftiritieri
cbrrespbadence dbout this. visit., :::: :.:: :
❑ Yes
Yes
(� No
No
❑ No
❑ Yes 0 No
❑ Yes P No
❑ Yes O No
❑ Yes No
❑ Yes V No
❑ Yes IN No
❑ Yes 93 No
❑ Yes CR No
PYes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
4- I-r se ede
W C�1� � 1 Vas-, t`� � +� 0 t- L4q�lQY� } �j ru7L11G �C �Qu� � • ..11
` z-. tr{1t�0.TlW� dezi5r l�1WVi� be 1t� t n� Y�L[0Y'Us.
If,,Ja 5kO+At 6.� 5�avt,} it fnk+j Y ftk to 5VV(17-5 of \qo.
7/25/97
Reviewer/Ins actor Name x `
p ,.» s"
Reviewer/Inspector Signature:L,____� �t�_ Date: p

❑ Division of Soil and Water Conservation ❑ Other Agency
P Division of Water Quality
Routine O Com laint O F611ow-u of DNV0 inspection O Follow-up of DSWC review O Other
Date of Inspection
L.. Facilit�•Number i 3-70
Time of Inspection 24 hr. (hh:mm)
Registered [3 Certified 13 Applied for Permit © Permitted 113 Not O erational Date Last Operated: „......••...
Farm Name: o s a?...... ` ...... �.......�.t.cr.�............................................................. County:...... 4n........................................ ........... .......
.....
Owner Name:......utY11a....?.�swtll................................................................................. Phone No: frta)zbz..poi...............................................
'(� 1� f
Facility Contact:.......�QViC.�.. .. �C ....... ................................ Title:.....QLaihf.Ar......................................... Phone No:.5, 1.9.). .7Xb ..............
MailingAddress: ,...g�e.1,.•,.. S. Q.G. ... ant a hJDSe....R1.4.......... .. �. i ................................................ .. �. N.................................
�. .
Onsite Representative:..- ..-. � � Integrator• ....... eA. �.
Certified Operator;........i�y ......:........ Vaj ................................ .................... Operator Certification Number, ..... isoo- t.......
Location of Farm:
ial4..-5.....}.14.�... s.......... tr,..... :.. Q...w.mt... ... .J.'.t4kl .:r�u:.........!! n..... .... ........... .............s.........,-.....5.11frx.:...�..trrx.,....�....1•....ar....
... C I e
4+autu"U I I {' I j -- LV11rjgUUG I I.... j
Destgu` Current Design Current.5 Design ;Current
Swine Capar�tiy Papuiat,on Poultryy Capactty,Populatton Cattle Capacity Population
M,.
OF
to Feeder ❑ Layer ❑Dairyz',
r to Finish ❑Nan -Layer
❑ Non Daisy
w to Wean _ a ❑ Otherw to Feeder _ z
. ElFarrow to Finish Total Design Capacity
❑Gilts
❑ Boars , Total SSFJO31
Number of Lagoons f Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area '
�.
�'* r
ro .... : ❑ No Liquid Waste Management System � , � Fl
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 convevance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes f?] No
c. If discharge is observed, what is the estimated flow in-aVmin? A-
-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 01 No
5. Does any part of the waste management system (other than lagoonstholding 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 [A No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes M No
7/25/97 Continued on back

Facility Number: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons.Holding Poilds. Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft):............................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
Structure 5
15. Crop type tin. ................................. ......... x1i.l�lc3i h.............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW vW)?
17. Does the facility have a lack of adequate acreage for land application?
18..Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency? '
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AW IP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violationsor deficiencies were noted -during' this' visit.', :Yodw_ill recei've•ito-further. . -
_
Ofrespondence dliout this'visi
S. nR,irrltiS Skau�� �pe bu: �{' Gf1�,n� �p�'A�-aC5 I GLa� lucir
�2 �ros:ar, WOGS o,n in►,.�- dry u011 S601d lap— A*j
Zz.. Corrat niAjm loji� 6e. vsra +o
L..GSei s�� rtttxS w L �c i.ogx,c (d ewift6s.
� �u� ,,;ask �► [ � uz}-►ati Mari �F. � n c,�,�dc, turd grouu�
Reviewer/Inspector Name
❑ Yes
roNo
❑ Yes
® No
Structure 6
❑ Yes
M No
❑ Yes
19 No
-N Yes
❑ No
❑ Yes
;kNo
❑ Yes
JKNo
❑ Yes
JANo
❑ Yes
RNo
❑ Yes
19-No
❑ Yes
O No
❑ Yes
PONo
❑ Yes
4 No
iO Yes
❑ No
❑ Yes R.9 No
❑ Yes P No
❑ Yes P9 No
etc
,y —a
roFta�i f de �Crr•i e",
�t �tt'Ir►wtt niflro�en wicoto -'n
for aa�l�ior�ct ac�rcage �o cvas4� apt{;ca,.
7/25/97
Reviewer/Inspector Signature: - Z , `nf Date:

Site Requires Immediate Attention:
Facility No. 31"370
DIVISION OF ENVIRONMENTAL MANAGEMENT
iANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: { .1995
Time: j 0 a
•
Farm Name/Owner._
Mailing Address:
u
County: — �[
Integrator: C42yzk t
Phone: �ZI 0
On Site Representative: AIWJ4
Phone: _ , 6, /012
Physical Address/Location:
�`-�° �' t l 4
Al~ r-►A72 r;
Type of Operation: Swine `�
Poultry
Cattle
Design Capacity: o- VOO ' Sdw
r
Number
of Animals on Site: Sr(N-i
DEM Certification Number:
ACE.
DEM Certification Number: ACNEW
Latitude: 07'4 y' %+a`"
Longitude: �1`�
7 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event -
(approximately 1 Foot + 7 inches) Yes or No Actudl Freeboard: _____Ft. �^ Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Deor No Is the cover crop adequate? e or No
Crop(s) being utilized: C[:t
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? Y�or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste Iand applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 9 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes 'or No
Additional Comments: 4' e f VY0
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed-

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