310375_INSPECTIONS_20171231

(, 3Y vision of Water Resources
,F acilit�# Number lW - 0 Division of Soil and Water Conservation 1
O Other Agency
Type of 'Visit: Momph a Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Q outine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: /Arrival Time: Z D Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: f r c La f' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Phone:
Certification Number: I5�- ,) & i­
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
I IEEJ
Design
Current
Dry Poultry
Capacity
Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes No 0 NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ONE
❑NA ❑NE
❑Yes ❑N ❑NA ❑NE
[—]Yes No. ® NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
Page I of 3 21412015 Continued

FacHity Number: - Date of Inspection:
WAte Collection & Treatment _�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2-7 0 y 279 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 17
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 7No ❑ 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 E�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
ff No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
[] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ff No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
Ej< ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E]-No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes fo NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes Og No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ffNo ❑ 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 ❑ NNc NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesFfNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of inspection: f
24 -Did thekracility fail to calibrate waste application equipment as required by the permit? Yes I 3 9- ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes No ❑ NA ONE
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a POA for sludge levels
0 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? Ej Yes No D NA Q NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No IA D NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
0 Yes ❑ No NA NE
Yes No ❑ NA ❑ NE
0 Yes CTNo [ NA ONE
❑ Yes % No DNA D NE
D Yes
E2rNo
Q NA
❑ NE
Yes
E2No
DNA
ONE
Yes
E No
D NA
❑ NE
�Connients (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better exalain•situations (use additional pages as necessary).
-59 -.-'L
Recfl'.1s e''- , le z
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
---,-_ A we �/
le
Phone: (�? 73o,V
Date:
21412015

Division of Water Quality
Facility Number _ 0 Division of Soil and Water Conservation.
0 Other Agency
Type of visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of visit: Arrival Time; �Departure Time: ` rj' unty:Region:
Farm Name: 70 4 ,:2 7Qi Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: (IJVam5
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer i I El
Non -La er
lets
Poults
Design Current
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure 0 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ® NA ❑ NE
Yes.,,ffNo ❑ NA 0 NE
Yes PrNo O NA ONE
© Yes No
Dyes 0 o
0 Yes ]rNo
[:]NA [—]NE
NA 0 NE
[:]NA [:]NE
Page I of 3 21412011 Continued

Facility Number: - Date of inspection: t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ili' No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes j�'' No ❑ NA ❑ NE
Struc. e I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: --, --
Designed Freeboard (in):
Observed Freeboard (in):—'�_-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ;?fNo ❑ 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 o ❑ 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
0 Yes
(;'►No
—
❑ NA
❑ NE
maintenance or improvement?
or
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
VNo
❑ 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
�r
X/ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
k(No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
;3No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
)2fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
C�rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tran%sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ['_'kTTo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ YesANo [] NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo NA ❑ NE
the appropriate box(es) below.
Q 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? E ] Yes OrNo ❑ 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 the 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?
fer to question #j:
of facility to better
Reviewer/Inspector Name:
any YES answers and/or any addi
situations (use additional uaees as
El Yes ;� No
Yes )ZI No
❑ Yes XN0
NA ❑ NE
❑ NA E] NE
[] NA [] NE
[] Yes [oNo © NA ❑ NE
Yes 0 No NA NE
[] Yes � No ❑ NA NE
El Yes �No NA Q NE
ons or any other comments.
Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3
I

ivision of Water Quality
Facility Number aL:0 7 0 Division of Soil and Water Conservation %
Other Agency \_
Type of Visit ,omC,ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10 Routine 0 Complaint © Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit. Arrival Timearture Time: County:
rs
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: %% Title:
Onsite Representative: 6%l r s: r
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Boars
Other
❑ Other
Phone:
Phone No:
Integrator: _ rz
Operator Certification Number:
Back-up Certification Number:
Region: C�� J
Latitude: = o = . Longitude: = ° = d
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La yer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkei Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a, Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Daia Calf
❑ Daia Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Dumber of Structures: O
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 P No ❑ NA ❑ NE
El Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes E�No ❑ NA ❑ NE
Page 1 of 3
12128104 Continued

Facility Number: Date of Inspection 13 Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E No ❑ NA [INE
a. If yes, is waste level into the structural freeboard? ❑ Yes VNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: y 7Gx
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �to ❑ NA [I NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P 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 7No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;ZNo ❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > io% 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 rJ 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
I8. Is there a lack of properly operating waste application equipment? ❑ Yes eNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name U Phone:
Reviewer/Inspector Signature: Date: 3 O
2 121210 Continued
p

Fa�cifity Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ W Dp ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes oNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking, ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ff No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
21 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
jzfNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
i� No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ff No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
2$. 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
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ej 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
2�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
1;3/1l0
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VfNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
a. 7U / �,/f `�I
r
J l� C `ice`
Page 3 of 3 12128104

-division of Water Quality /
Fack[ity Number 7 Q Division of Soil and Water Conservation
Q Other Agency t/
Type of Visit AErIC5ompliance Inspection d Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit,01outine O Complaint O Fallow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: /� Arrival Time: /1 v o eparture Time: County: Region:Gl
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ��� r a k/—f
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede:
Farrow to Finish
Boars
Other
❑ Other
Phone No:
Integrator: z/_ /�
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = . r Longitude: = ° = �
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [R'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
❑]N'o
El Yes
�J No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;?�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes gNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: dZZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P�N o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ YesTo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JeNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) j
9. Does any part of the waste management system other than the waste structures require El Yes IL[ No ❑ NA ❑ NE
maintenance or improvement? /
Waste ApDlication
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 VrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus []Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outsidc of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes_,(No
❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
, No
�J
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Rf No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
/No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use.drawmgs, of facility, to better,,explain situathms. (use additional pages.,as necessary);
Reviewer/inspector Name Phone:�(�'��
Reviewer/Irtspector Signature: Date: y D
Page 2 of 3 121AI04 Continued

Facility ]number: Date of Inspection (�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pen -nit readily available? ❑ Yes ZNo ❑ 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. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I(d No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
4o
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
7No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Commentsand/or Drawings:
❑ Yes
U&
❑ NA
❑ NE
❑ Yes
9(No
❑ NA
❑ NE
❑ Yes
9(`No
El NA
El NE
El!� Yes
1 No
❑ NA
❑ NE
❑ Yes
1�'4o
❑ NA
❑ NE
❑ Yes
LINO
❑ NA
❑ NE
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number 7 0 Division of Soil and Water Conservation '�
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: `Departure Time: County:
Farm Name: _ 71:2� Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: % Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
/JP/hhone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , = « Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
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?
G�
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

r
t
Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 7No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ON. ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: z7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .52=
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ kNo El NA El NE
(ie/ large trees, severe erosion, seepage, etc.) //
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ 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
VrNo
❑ 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
[;�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1XNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�/
Ld No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN Q 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
I2. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes `VNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
YNo
❑ 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
[XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

yf 4
I
Facility Number. <5-31 - Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ?No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (" No ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists © Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
O�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
Jo
❑ NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[�o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
2K0
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑o
❑ NA
❑ NE
Other Issues
/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�!o
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
E10
❑ 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 concem?
❑ Yes
[)Mo
❑ 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
PrNo
❑ 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
['Vo..
[I NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
&-'N
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
I2128104
I2128104

Q Division of Water Quality
Facility Number © Division of Soil and Water Conservation
0 Other Agency y
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: G �% Arriwal T' e: =Departure Time: County:
Farm Name: 4c— Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: r i
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone:
Phone
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o Q , Longitude: = ° = , "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 0
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 jZfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
�] Yes
P^No
ElYesrNo
o
El NA
[I NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
t
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?
Z �� � Structure-? Structure 3 Structure 4
Identifier:
❑ Yes [; o ❑ NA ❑ NE
❑ YesCZ'No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )2 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 NNo
❑ 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 P o
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El L�'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 JZ<o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
I0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I—o
J'
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 tbs ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
T o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes_;BNo
�YNo
❑ NA
❑ NE
18. Is there a Iack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question 4): 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):
ILI
Reviewer/Inspector Name Phone: C�
Reviewer/Inspector Signature: Date:
12128104 1Continued

Facility Number: Date of Inspection 37
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists Q Design ❑Maps Q Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard C] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Q Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes JZNo
Q NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Q Yes
o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[r�4o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
Q Yes
EYNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
YNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3fo
❑ 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
[rNo
❑ 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
VNo
Q NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Q Yes
CT'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
grNo
❑ NA
Q NE
Additional Comments and/or Drawings:
7�7C4 71- {'
I2128104

Division of Water Quality
Facility Number 7� � � o Division of Soil and Water Conservation
O Other Agency
Type of Visit erCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visivl!51Routine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: g Arrival Time: / r J%J Departure Time: County:
Farm Name: 2 :ZG V L Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: % Title:
�
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region:
PPhone No:
Integrator: 16w4t
Operator Certification{ Number:
Back-up Certification Number:
Latitude: = o = ' = « Longitude: = ° =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean O
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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
❑ Beel`Brood Cow
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
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number:;— Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
Cl Yes
❑ No
❑ NA
❑ NE
Structure Struoge 2 Structure 3 Structure 4
(J�j
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —s-�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
[] Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvernent?
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 > l0% or 1 O Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind w %❑l Evidence of Wind Drift ❑ Application Outside o Area
12. Crop type(s) /?" (.`� C ), <� �G't � C` �P cs�/
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
CComments (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):
etC ar,;S /�4/ "'- o r ffC '- - / tX
Reviewer/Inspector Name Phone: 7, 4;.` � it
Reviewer/Inspector Signature: r% Date: !f
Pawn 2 of 12/2N104 rantiriued

Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
[] WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
A�
r
Page 3 of 3 12128104

Division of Water Quality
1114veffity Number 3 O Division of Soil and Water Conservation �n1r
Q Other Agency
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 94tbutine Q Complaint O Follow up O Referral © Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: r0 + Departure Time: County: Region:
Farm Name:o 7� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:�C
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: Q =' =" Longitude:
S'Mu e
Wean to Finish
Wean to Feeder
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Farrow to Wean (�
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Other
Dry Poultry
❑ Layers
El Non -Layers
❑ Pullets
© Turkeys
❑ Turkey Pouits
❑ Either
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifea
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 eNo ❑ NA ❑ NE
El Yes
El No
El NA
El NE
❑Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued ,

Facility N4mber: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
S r 1 Structu e 2 Structure 3 Structure 4
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier: (—/4
Spillway?: /
Designed Freeboard (in): Ze< t�
Observed Freeboard (in): �' 0 —, 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fait 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
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Nance v `` Phone:
Reviewer/Inspector Signature: Date: .9
12/28)F4 - Continued

Faciti y�mber: 3� Date of Inspection
Regnired Records & Documents
14. 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 appropiate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El other
21, Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NF_
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Iaspector 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
0 NE
Additional Comments and/orDrawings: OR
OW Auff
�- f� d /7 �
- d�J 1 7
12128104

rvisiori ofWater �"It3'
_Qu-
_ ,Division ofSoit-and Water Conservat,on
=... .. a Other Aged
(Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit CrRoutine 0 Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date or visit: j Time: C5
Not O erational O Below Threshold
XPermitte��Cerfified [3 Conditionally Certified [3Registered Date Last Operated or Above Threshold: .........................
Farm Name:t5 ................ .............. •---....
Owner Name: ...-
Mailing Address:
Phone No:
Facility Contact:............_........................_...................................... Title:..--......._.. _. Phone No:
Onsite Representative:.........,, ,; , ,i�?� ---------_- Integrator:............ .....................
CertifiedOperator: . ................................................. ..................... ....................... ............... Operator Certification Number:
Location of Farm:
I'r
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0• �` �" Longitude �' �` �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
arrow to Wean
❑ Farrow to Feeder Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total SSLW
Number=of Lagoons I II I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 044-0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes /No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure b
6LI
Identifier: ....................... ......{. ......- .... �..__....,_ ....... a.................... ........... .................... .
Freeboard (inches):? 0
12112103 Continued

Facility Number: — ] Date of Inspection f
5: Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ' No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ;eo
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? ❑ Ynq ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �Io
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? [] Yes
I I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Pbnding [IPAN ElHydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type K A S
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
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes FNV
15. Does the receiving crop need improvement? El Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes To
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes MXNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [] Yes io
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 is
Air Quality representative immediately.
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): [] Field Copy ❑ Final Notes
C ocJ SPOT- 3::0 VsGL,� 6E DS s dVV-\ E ff �Za VGM(Arj
PL'u' F I, G
FrAg,j\ 21 ow
vF DAT`?T-CLD �6r�rrn
1ZC c o s {.0011 C I-D.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 14 f 5
12112103 F Continued

Facility Number; — Date of Inspection
Required Records & Documents
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?
(ie/ 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?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
TNPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. 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?
❑ Yes N
❑ Yes N
❑ Yes No r
❑ Yes L'J No
El Yes /Oz
EEO]Yes
Yes
El Yes N
El Yes No
des ❑
❑ Yes Lam!
❑ Yes
❑ Yes L d1V
❑ Yes No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Date of Visit: �3 p Z Time: � �G'
Facility Number 31 ,� r%S"
Not O erational Q Below Threshold
[] Permitted E3 Certified [3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold: ........---..
Farm Name: .-........ .. .4.. ... �� . 7.'. t2...................................... County:.. f."� - -- -- -- --......... _................
af,f o li 3 F'a�ds,-�
OwnerName:.------ -------------- -------------_--- ---------------- Phone No: _ ---------------------•--_-----••------------
Mailing Address: .............................. ..... . ...... .
Facility Contact: .............................. .......................... Title: ....... Phone No:
On site Representative: _--`�------ u;'S---------------------------- Integrator: -__� rf p'�--------- ----_ _.------
Certified Operator: ............................ ...... .:.......... .......---••.................................................... Operator Certification Number:
Location of Farm:
s
v
wine ❑ Poultry 0 Cattle ❑ Horse Latitude • & 0" Longitude • °
Design Current
Swine Canacitv ':Population
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
�, d
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity population Cattle Capacity Population
Layer I I ❑ Dairy
❑ Non -Layer I I JEI Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 1E1 Subsurface Drains Present I � Lagoon. Area JE1 Spray Fietd Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is aay 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 XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E!(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 'ONo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure ti
Identifier: ........... : Z.. 2. 0 &.- -- -- ................ ........................... ............... ...... •-............................
Freeboard (inches): 14 - 45
nrin�tnr If,-_..-----1

v.3IVJ/Vt c,anrrnuctt
F"aci*ity Number: 3 1 —.3 ? Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Qf 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 ONO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ONo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes )ErNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes dNo
11. Is there evidence of over application? ❑ Excessive Ponding ,Q'PAN ❑ Hydraulic Overload XYes ❑ No
12. Crop type 13 c r vn tA�j W r! j ge"'- s h
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management. Plan (CAWMP)? ElYesNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONo
b) Does the facility need a wettable acre determination? ❑ Yes XNo
c) 'This facility is pended for a wettable acre determination? ❑ Yes �fNo
15. Does the receiving crop need improvement? ❑ Yes []No
16. Is there a lack of adequate waste application equipment? ❑ Yes ZNo
Required Records & Documents
17. Fail to have Certificate of Coverage & GeneraI 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?
(ic/ Wi,7P, checklists, design, maps, etc.) ❑ Yes ,0 No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ZNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes XNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ,,JI No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ErYes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes JVNo
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)ZNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question_# j Explain anyYES'answeis and(or any recommendations or a a
Yoh
Use drawings €sf facility to better explain situations (use additional pages as necessary} 0 Field Copy [I Final Notes '=
f l . I� c. r .�... ; S a � C .- Oi .-� i r^F1 z' ,�. d � r .� � I e -� �+✓ i .^LC cs !�' -�'t� s j O D I � S D r� sw, cs 1 I � �'t�.i � .
6v, -Jzaoz
'.
-eke 4e 2.601 srr►iall 5 J nv of 63 [ �
ct L � � I✓ 1 �' G3 C C- 1 Ve I ! h � S-; -e. w; ,,t c, w .
1ieXceeeA ',ti J
Sd r&s q sr �e. �,> .%/,
15 - /Ue+e ©( 4 o C v4 e,-,A b a 1 e sr-"Q 1 I �� �., a re~ Ve i,�n �' ►c d,•� et y . Qelvrk3a44
f
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

I
4
* Facility Number:
Date of Inspection 2 Q 2
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
)Zryes ❑ No
❑ Yes ,ZNo
❑ Yes VNo
❑ Yes ONo
❑ Yes No
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or Drawings; -
?, N eeL1l -� 1,c 6enc-A :I t.j I-,e viol S Yt -20 03, Or o
lr,grlc ���Y of 4 ke Brie did: 2..019 1 . J
cfc , J 5 0+ wo-<4 e � v�(oi l e �L, )^ P
�vnl �R,rovq� sp�O%`��'i �!� Ares, D�` ti�rdrq✓74 �hc
te c l e f e qo vr� n G►{` i' i ^� 1 v14 o Gi low ive-4
I j. T �� ovc�ac�� a�► f2 � 2E" ce
am b
4D Wtt r,tI� +� a b C r r&'t V d q S "C e
t i
fi C. [,V! ✓�/j �~f %'yit.Ll . e Q�C� 01 .. '
dv1 16 a L1_�V!'a' G�/I ill 6 c-4obe r eq&'V4
4Le,e-l-re-e 6cfono4 be &o,,LP1 co( 4,, 6c,,-,vdq
Avid 'S overArr11czA4 ox-\ ,
OS103101

"Division of Water Quality
0 Division of Soil and Water Conservation
O Other Agency
(Type of Visit f0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Agoutine O Complaint O Follow up O Emergency Notification O Other
jj ElDenied Access
�-�—f_
Facility Number Date of Visit: Time. ] Printed fin: 10/26/2000
Q Not O erational 0 Below Threshold
Permitted © C 'fled ® Conditionally Certified [j Registered Date Gast Operate or Above Threshold: ...........
Farm Name: ...... YY 15........ ..!. .. . �l ,./ County:......... 4. P..�i!L'L�.........................! ,,� ..........
Owner Name:
Facility Contact:.............................................................................. Title:
MailingAddress:............................................................................
Onsite Representative: .. ....
Certified Operator:,._,.,,,,
Location of Farm:
Phone No:
Phone No:
Integrator:........ ... 1
....................................I..........
.................. Operator Certification Number:..........................................
t
Swine []Poultry []Cattle []Horse Latitude 0 �� �•z Longitude ' ` 44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer 1[1 Non -Dairy
arrow to Wean zi400
El Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑ Yes KNo
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, notifv 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?
Structure 1
Structure 2 Structure
Identifier: ...........!..............
.......... 0- .............. ................. ........... .
Freeboard (inches):
5100
Il
❑ Spil [way
Structure 4 Structure 5
❑ Yes
❑ No
Yes
❑ No
❑ Yes
5N0
❑ Yes
No
❑ Yes XNo
Structure 6
Continued on back

Ficility Number: -� — ? 7 Date of Inspection 2 Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures obse e ? (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
ffNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VNo
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
lNo
11. Is there evidence of ver applicatior19 ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
®No
12. Crop type
13. Do the receiving crops (iffer 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
ONO
15. Does the receiving crop need improvement?
❑ Yes
WNo
16. Is there a lack of adequate waste application equipment?
0 Yes
dNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNO
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
o
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�eNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J160
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
W40
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ief discharge, freeboard problems, over application)
❑ Yes
A�No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VNo
24.
Does facility require a follow-up visit by same agency?
El Yes
�10
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�dNo
Rio-viola(iqris:oi- ftrj e&' ry r� po(et dtWing this:visiti - Y:oit <dj,teegiye tat► futthtr ,
coriesporide' e: ahbuk this visit` ..... ' . . .
FUs
mme drenfs (refer toquestion #). Explain any DES answers and/or any recommendations or'auy other cotmui�r.awings of facility to better explain situations, (use additional pages as necessary): p _fir t a
�% `tea l %-i 01 %�i'� WG�' rt,� v► V7���ra�
19A .ram' /
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5/00

IFacility Number: Date of Inspection Printed on: 10/26/2000
Odar Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [j Yes 6No
liquid level of lagoon or storage pond with no agitation'?
27. Are there any dead animals not disposed of properly within 24 hours? El Yes �60
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes rNo
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 00
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? [J Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes tj�No
At
5100

' [ t
13 Division of Soil and Water Conservation - Operation Review
r - Q Division of Soil and Water Conservation - Compliance Inspection
E[Divisioin of Water Quality -Compliance Inspection
0 Other Agency - Operation Review
JaRoutine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number
Date of Inspection -:5,
y�no
Time of Inspection 24 hr. (hh:mm)
Permitted Q Certified 0 Conditionally Certified 0 Registered 0 Not Operational Date Last Operated:
(� /�� r! r� %�..............
Farm Name: ............. 4AY.y'�.� ...........,C.0F ►v' `l �..�1>t County:.....................,...1.l".?..........................`'.:...........
...... ............��................. L J Lt
Owner Name:� y �.,:5 Phone No:
.......... ..................... a
Facility Contact: ....... rGC / 1'1...................... Title: I rv1.., .. Phone No: ........................................... ........
Mailing Address: ........................................ .......
Onsite Representative: _..yDI!(���GYCII ?/L
Certified Operator:
Location of Farm:
Integrator: .............CCkL �V r...................... ............._..............
Operator Certification Number:
Latitude 0 6 & Longitude • ° 46
Swine
Design Current Design Current
Capacity Population Poultry Capacity Population
JEI Layer
10 Non -Layer
❑ Wean to Feeder
❑ Feeder to Finish
RFarrow to Wean
1-iloo
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
...........................� •r
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �f No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [:]No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? H -
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes [3No
2. Is there evidence of past discharge from any part of the operation? El Yes [A No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [3�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ANo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ? 701 a774) �
Freeboard (inches): ...............
3 3 "'
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ANo
seepage, etc.)
3/23/99 Continued on back

Facility Number. -2, Date of Inspection -; >
6. Arie there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes o
(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 E]rNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes IKNo
9. Do any stuctures Iack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes E No
Waste Annlication
10- Are there any buffers that need maintenance/improvement?
❑ Yes
'/No
11. Is there evidence of over applic n? ❑ Excessive Ponding [] PAN
12. Crop type
❑ Yes
VNO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
E 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?
fyYes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
&No
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
IZNo
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
o
19.
Does record keeping need improvement? (ie/ irrigation, frecboard, waste analysis & soil sample reports)
❑ Yes
RNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
rO No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[3,No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ief discharge, freeboard problems, over application)
El
IdNo
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
ONo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONo
�; N,6 - 06 ati6fis ;Q r- def eie?nvip$ -s ere po#ea- dtWiiid �his.v. sit. Y oit 'Wd. r&6*0 do, fufr h(er ;
corres�oridertce: about; this visit.::::::
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments..
Use drawings of facility to better explain situations. (use additional pages as necessary):
NpTes a-F
rn t.s +rt 1 -A�s t~ i n vt14 -
10� �vt
t
kj - c> fvv az IM-oU-v ne wu 1� I �
£, k} tr- 'DWQ
%� ,�-]-7 p !, a s a!- 5 3 3. = nr; p ca! I 2.,,.� . ct �v,�-f� •-K�a s i s s ��.t. -
Reviewer/Inspector Name y Gt 1,e& /t r Alf y 1 41(%A_
Reviewer/Inspector Signature — ,/j/f ./ p Date:

Facility Number: 1; 3�� Date of Inspection �-S • Yl
Odnr�lssues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ YesNo
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 Q�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 f�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 O,No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes PiNo
32. Do the flush tanks lack a submerged fill pipe or a permancnt/temporary cover? ❑ Yes 0 No
Additional ominents ad"" or swings:
3/23199

' 9 yI /-
, W,
2 4
are��"w
Revised April 20, 1999
'JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 2% -- Operation is flagged for a wettable
Farm Name:',�'S^.(t'� �7L ._ acre determination due to failire of-�
On -Site Representative:_= Part it eligibility item(s) F1 Cjff-F3 1,E4�
InspectorlReviewer's Name: Lr`lC�°,'lf/. Operation not required to secure WA
determination at this time based on
Date of site visit:_ z� exemption E1 E2 E3 E4
Date of most recent WUP: Operation pended for wettable acre
'S determination based on P1 P2 P3
Annual farm PAN deficit: % pound! s
Irrigation System(s) - circle #: 1. hard -hose traveler, 2 center -pivot system; 3. linear move system;
4. stationary sprinkler system wlpermanent pipe; a, stationary sprinkler system wlportable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system wlportable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D21D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an 1 or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part 111. (NOT E:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part It. Complete eligibility
checklist, Part II - F1 F2 F3, before completing computational table in Part III).
PART H. 75% Rule _Eligibility Checklist and .Documentation of WA Determination
Requirements. WAy. Determination -required -because . operation , ails Wine of the .eligibility
requirements listed below:
_ F1 Lack of:acreagewhichTesulteddnmver:applicauon-mf_wastewater_(PAN) on:spray_
r fife]d(s)�ccording�ojarm'sdasttwo �ears�f-iiiio ga n7ecords
V_
_ F2 Unc]ear,-:illegible,-:qr lack of -iniomzationfmap.
F3 Obviousfield-iimitations-(nurnerous:ditches;�aiiura:-to:deductTequired:—
bufedsetbackmcreage;_or26%-of totalacreagesdentmedsr7LAWN1 ::includes_ _
small, irregulariyzFapedfelds;Melds_lessfhan-5mcres7ortravelers orJess-ihan --
2 acrestor.-stationary-sprinklers).
C%r
F4 WA determination required because CAWNIP -credits - ieId(s)'s acreage in excess
of 75% of the respective Yield's total acreage as noted in table in Part Ill.

3
Revised April 20, 1999
Facility Number-
Part Ill. Field by Field Determination of «/° txemption Kule for WA uetermination
TRACT
NUMBER
FIELD
NUMl3ER'�
TYPE OF
IRRIGATION SYSTEM
TOTAL
ACRES
CAWMP FIELD
ACRES
COMMENTS3
/M3
/
)
I
v
I
I
!
I
I I
L
IF
I
I
I
I
I
I
1
1
I
I
I
I
I
I
IF-
I
I
I
I
I
I -
I
I
I
I
I
I
I
!
I
I
I
FIELD NUMBEW - hydrant, null, zone, or.point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation -system. If pulls, etc. cross -more-than one field, inspectudreviewer will have to combine fields to
caicuiate 75% field by field date-n-nination for exempwon;-otherwise operation, Vill be subject to WA determination.
FIELD NUMBERZ - must be clearly delineated on -map.
COMMENTS'- back-up fields with CAWMP acFeage-exceedingg5a% of its total_acres and havingTeceived lass fi�;an 50%
of its annual PAN as -documented in the- l'arm's:prsvious-two years' ('1g97 & 1298) of irrigation -records, cannot serve -as -the
sole basis -for -requiring a WA Determination --:.Back-up fields -must be -noted in the -commentzeuvon-and must be accessible
by irrigation system.
Part IV. Pending WA -Determinations -
_P1 Plan Jacks: following information:-
P2 Plan -revision -may_sabsfy-.75% rule based can adequate overa l PIdefjcit and by
adjusting -all fieldacreage:to-below 75% use rate
P3 Other (ie/in process of installing new irrigation system

-7 4 WO L - I ;'tI-
� Revised Apri120, 1999
-JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number, -
Farm Name:.y'�
On -Site Representative:
InspectorlReviewer's Name:_ 1 (f?(� IYI�C'1��✓
Date of site visit: -,
Date of most recent WUP: y ? c5
Annual farm PAN deficit: -_? pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility item(s) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #-- 1. hard-hosetmveler, 2. center_pivot system; 3. linear move system;
4. stationary sprinkler system w/permanent pipe; 6. stationary sprinkler system wlportable pipe;
6. stationary gun system wfpermanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE.:76 % exemption cannot be
applied to farms that fail the eligibility checklist in Part IL Complete eligibility
checklist, Part 11- F1 F2 F3, before completing computational fable in Part ill).
PART 11. 75% Rule _Eligibility Checklist and .Documentation of WA determination
Requirements. WA Determination.requiredbecauSe.operation!ails Dne of the.eliaibility
requirements listed%elow:
_ F1 Lack.of:acreage_whichTesuitedan:Dvermpplicabon-mf-wastewater=(PAN) on:sPray-
field(s)mccordingfodarm'sdasttwo--yeasmf-iii gaaionzecords:
F2 Uncl ar,-illeaible::or lack of informationlmp.
F3 Obvious--r-ield-limitations-(numerous3jitches;dailure:-to=deductTequired._
bufzerlsetback-acreage;mr26%.cif#otalzacreage-identified:iriEAWMP::includes:- _
small, -irregularlyshaped -fields �- ields:less-1han75mcres- ortravelers or.less- han
2 acres -for.stationarysprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part Ill.

4
14 %�r
Revised April 20, 1999
Facility Number.
Part Ill. Field
by Field uetermination oT 10% txemption Kure Tor ► VA uetermination
TRACT
NUMBER
FIELD
NUMBER',7
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP FIELD
ACRES %
COMMENTS3
ZOf
o-20-7
7 )dr0
I
I
I
!
I I
!
I
I
I
I
I
I
I
I I
1
!
11
1
I
I
I
!
I
I I
!
I
I
I
I
I
I
I
I
I I
FIELD NUMBER' - hydrant, pull,zone, or:point numbers Tnay be used in place of field numbers depending on CAWMP
and type of irrigation -System. If pulls, etc. cross -more -than one field, inspectodreviewer will have to combine fields to
talc tiate 75%T!_1d by field idete-n;^.a:hon for ex--rr..t:onT -the-wise operation ."III: be subject to Wtl% detciiri: Iat t.
FIELD NUMBER2 - must be: clearly delineated on -map.
COMMENTS' - back-up fields with CAWMP acreage xceeding7b% of its total:acres-and havingTeceived less than 80%
of its annual PAN as documented in the iarm`sprevious.two years` (1997 & 1998) of imgation-records,-cannot serve -as -the
sole basis -for -requiring a WA Determ_ination::.Back-unfieldsTnust-be noted in the-cornmentaection-and mustbe accessible
by irrigation system.
Part IV. PendiADeterinations -
zP1 Plan Jarks Jollowing information: �
P2 Plan revision -may_satis y75% rule based on adequate overall PAN deficit -and by
adjusting -all fieldacreagedo below 75% use rate
P3 Other (iern process of installing new irrigation system):.

Water Quality Active Lagoon Rankin
Draft
Central Office Criteria
1. Was facility constructed before 1993 NRCS Standards or there is no verification of standard?
2. Plana Available Nitrogen (PAN) Deficit < 500 - per vear or F1. F3 or F4 Wettable Acre Determination
Fla,zs
FI Lack of Acreane resulted in over application in last two vears
F3 Obvious field Iimitations ditches_ buffers irregular shape
F4 Application acreage in excess of 75% of total acreage
3. Lagoon Capacity greater than 1,000.000 cubic feet
4. Was there a discharge from waste system in last five years?
Central Office Criteria available after new verified GIS data is gathered from field GPS Units
5. Distance from Lagoon to Water of the State (WOS) > 300'?
6. Is lagoon in 100 year flood plain?
Field Inspector Criteria
7. Modify Question i�4 from current inspection. add choice box: Is high freeboard due to storm water or
management" �f
"33
S_ Modify Question T 5 from current inspection form (take immediate out) and define in form instructions:
Current question: Are there immediate threats to the integrit,, of any of the structures observed? (trees,
erosion) / Oq z70q. 27rJ�
9. Add question on effective embankment Height > 10' 1a�1
2/3100

9�/26/2999 15:28 919-715-6948 DWQ NON DISCHARGE BR PAGE 92/03
1=aoiliy Number Lagoon Number - Lagoon Identifier _...._._,_:r��.. -..
Active 0 Inactive Latitude
Waste Last Added ..�....,µ�,�------._..d. �. Longitude
Determined by: ❑ Owner ❑ Estimated By GPS or Map? GPS ❑Map
%.'L/- G P S file number: Q
L
Surface Area (acres):
Embankment Height (feet):
Distance to Stream: O <250 feet *5fl_feet - 1000 feet Q >1000 feet
By measurement or Map? [] Field Measurement grMap
Down gradient well within 250 feet? O Yes No
Intervening Stream? O Yes 040
Distance to WS or HOW (miles): O < 5 / 5 - 10 4 e>-1-0
Overtopping from Outside Waters? O Yes tK40 O Unknown
Constructed before 1993 NRCS Standards? O Yes 0_Na
No verification of adherence to 1993 NRCS Standards? O Yes ONO
Was groundwater encountered during construction? O Yes Q No
Depth to Groundwater:
Discharge within last 5 years? Q Yes o
Within 100 year floodplain? O Yes No
Immediate threat to the integrity of the structure? 0 Yes No
Spillway O Yes �No Adequate Marker *yes Q No.
f
Freeboard & Storm Storage Requirement (inches):. �....._., ,...,�.�

r
Division of Soil and Water Conservation - Operation Review
0 Division of Soil and Water Conservation - Compliance Inspection d
Division of Water Quality - Compliance Inspection -
0 Other Agency - Operation Review
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number . _._�,..�. Date of Inspection
Time of InspectionH!2 24 hr. (hh:mmj
n Permitted 0 Certified (3 Conditionally Certified © Registered [3 Not O erational Date Last Operated:
Farm Name: ........... ...................... County:.....�..0 p t .'
Owner Name:....... Phone No:
Facility Contact: ............................................... .. Title:.........,... .. Phone No:
MailingAddress: ............................ ..............................................................._..................... ..........................
Onsite Representative:.M.� �7NA.r.. �`Ix2....lri.... Integrator .......x14IL-............................................
f..
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
.........................................................................................................
Latitude 0 4 Longitude �� 0`
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 Population
❑ Layer ❑ Dairy
❑ Non -Layer 1E] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
,Number of Lagoons ❑ Subsurface Drains Present Lagoon Area 1E1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ONo
Discharge originated at: [:]Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was die conveyance man-made?
❑ Yes
ff No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
eNo
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
[?fNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [] Yes
2fNo
Waste Collection & Treatment
❑ Spillway
❑ Yes
RNo_
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure fi
Identifier: �. �
Freeboard (inches): t .................. .... ......... I ........ ......
..................................
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

-2' 0
Facility Number: 31 — Dale of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 0 No
❑ Yes )zNo
❑ Yes P'No
El Yes PNo
Waste ,application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
2r o
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
ZrNo
12.
Crop type C-- 1<a-PA40-A- ;I S . C— F_14c�i c(
13.
Do the receiving crops differ with those desi noted in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes RrNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
Vivo
b) Does the facility need a wettable acre determination?
❑ Yes
4�fNo
c) This facility is pended for a wettable acre determination?
es
❑ No
15.
Does the receiving crop need improvement?
[IYes
ONO
16.
Is there a lack of adequate waste application equipment?
❑ Yes
�No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? - ❑ Yes ZrNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLT, checklists, design, maps, etc.) ❑ Yes �No
19. Does record keeping need improvement? (ie/ irrigation, freeb+�d, waste analysis& soil same reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes LTNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ;ZN0
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) El Yes ONo
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 ZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,;'No
violations'or dei�i,ciendes -were hated• dii-ting this:visit: "ir :will reeeiye Rio further -
corres' 6iideiace. about this visit.
:Comments (refer to :question #) Explain,any YES Answers and/or any recommendations or any other comments;
Use drawings of facility to better g ty explaiasituations .{use additional pages as necessary);
l5) A A, r ->_L o J ALS— f d � � C- a del Qbt4,o - � r� CN r 4� � A �
f-k `cam T ,_N.fAL_ ) GT-44--5 E, ma's 7-Ag is 5 01q7 W�tm nn Pr,JTA(%J't~ D
Reviewer/Inspector Name
Reviewer/Inspector Signature:
f,;T ) _g 71 -q' 7 cb
Date:
3/23/99

i. z7 f.
Facility Number: 37 Date of Inspection 1 -7 Z
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29_ Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover?
Yes ❑ No
❑ Yes dNo
0 Yes VNo
❑ Yes j f No
Yes VNo
Yes 7No
❑ Yes ZNo
Additional Comments and/orDrawings:
1 i -zy f/�(C £�S' ,� .Et.J� F �9t-zC LAGE r.J
AL
M d4F
:5 f .f.�P St° < <-� 6a� i r1 C�►�A�Jc.D '�ann 6��Er��N t�ro+�'S,
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
�> Division of Water Quality
`
® Q Y
Routine 0 Complaint 0 Follow-up of I)NVQ inspection 0 Follow-up of WSWC. review 0 Other
Date of Inspection 5 1 Z c
Facility Number "lam
Time of Inspection { f ZQ 24 hr. (hh:mm)
[3 Registered ElCertified © Applied for Permit d Permitted JUNot2yerational I Date Last Operated:
Farm Name:......... 0 .�.. . �1?. a ....................... County: ,;rw ............... I......................
Phone Flo• 0`
Ov<<rier Name: .......... �.}..�,a.Yti11.�.�.�....... ........h............................................._...................... � .....��.�......?...�.9�:..�'�.�!�.........................................
Facility Contact: .........S.,refi yr .......... Title: ,..4� 1�£1.................. Phone No:
Mailing Address: ....... ��...a.... .................... ........ .... .......... .....ts�cua�. ��- Z$34�......... .................................................. ..........,...
Onsite Representative:............. . ({Mr ....................................... ...... Integrator ......... cw'. A f.5...................
Certified Operator: ................ _.........._...... ...... ................... ........................... .................. Operator Certification Number:........................
Location of Farm:
.....�R_..9S..1...1.a...wi.l.cs.....SAttFh....o.t<...itw;. r.........................................................................................................&
............................................................. ....... ......
Latitude �• ��
Design Current
Swine Capacity Population
❑ Wean to Feeder
V
❑ Feeder to Finish
Farrow to Wean
3 00
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude
Design Current Design,
Poultry Capacity Population Cattle Capacit
❑ Layer JE1 Dairy
❑ Non -Layer JEI Nan -Dairy
❑ Other
Tti~tal Design Capacity
Total SSLW C
Number of Lagoons 1 Holding Ponds: ❑ Subsurface Drains Present ❑ Lagoon Area ❑ 5prav Field Area
10 No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? Q Yes No
2. Is any discharge observed from any part of the operation? Q Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
No
[] Yes
[ No
❑ Yes
No
❑ Yes
No
❑ Yes [A Na
Yes ❑ No
❑ Yes No
❑ Yes No
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes K No
Structures (Lagoons.Holding Ponds. Flush Pits, ete.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: � .! . 776(a .................................................._..................,.........................,........................................ _..................VV....,,..[[..................
Freeboard(ft):...........L.6...........................4.: ... I ............. ...... ...... ......... . . ...... .................... . .............. ....................................................... .......... .... ..
10. Is seepage observed from any of the structures'? Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12, Do any of the structures need maiiitcnance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'? ❑ Yes No
Waste .Application
14. Is there physical evidence of over application? ❑ Yes ® No
(If in excess of W MP, or runoff entering waters of the State. notify DWQ)15, _
Ptype 4_ ........ ............................................................................
lb. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 0 No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes jai No
18. Does the receiving crop need improvement? rt"Yes. ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes (WNo
20. Does facility require a follow-up visit by same agency? JW Yes ❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes RNo
r
22. Does record keeping need improvement? ❑ Yes gNo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? 0 Yes M No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No violations or deficiencies were noted during this. visit. Youmill receive no further
correspondence about this visit:
❑ Yes. ,I No
❑ Yes IM No
Comments (refer. to question #):: Explain any ITS answers and/or any recommendations or any other comments ,
Use drawings of facility to better. explain situations. (use additional: pages as necessary):
5. Gmsi, WOAWe4 [1Vs. ��iQI�FU I skoel� he in.�YavgV iC� �l2J�k' runo� e} Gyo.S aV, � L-nW ��cc S i A-
tl 'SY�fD W 41La 10se W t,3e4A
�
5 , t.u,�'�je.� �W40 i,�mor, G uEl sf�ulc� 6� [awxrj IV,_ a m rrs��qtblC f
ta.`�aSs`nG see o+ '`11 "R of 2-l'©b t&VOn. Ate& S" (De mont�rc� � ec.Sv►e t�+{tsi�t�
� d :Its wg11. �� }} ``
12. Er"ra+, �1 0,. 0t6' J,k4 C.-U- l 0+ ?--A*i a�aa,� &koW�1 be- pvyri &ud - a -prc v� t � tt m-
_t
t,�nrj& S ItJ �Q n,at, � b C+�svw •*s`tc`tf ��y{�c t�� ecT4- aYLa. 7/25/97
7
Reviewer/Inspector Name
Reviewer/Inspector Signature: ;I,ti,L, 4r: Date:

CARROLL'S FOODS, INC.
P. O. Drawer 856
WARSAW, NORTH CAROLINA 28W8
May 22, 1998
Mr. Brian Wrenn
NCDENR
127 N. Cardinal Drive
Wilmington, NC 28405
Re: Correction of Deficiency
Farm #2704/2706
Facility #31-375
Dear Mr. Wrenn:
The lagoon at Farm #2706 has been pumped to approximately 22" which provides the
19" freeboard and 3" into the temporary storage. We will continue to pump as crop
requirements and weather permits until the stop pump point is reached. The seepage area
on the outer dike has dried up. I'm sure it was only rainwater seepage on the outer dike
due to the excessive rainfall. As time and weather permits the grassed waterway in held
#1 will be improved to prevent runoff and erosion.
Sincerely,
4A"
Fred Cumbo
Environmental Technician
FC:cs

Y � .
[j DSWC Animal Feedlot Operation Review
i
�DW( Animal Feedlot Operation Site Inspection .
0 Routine Q Complaint 0 Follow-up of DWQ inspection O Follow-uo of DSWC review © Other
Facility NumberEIZD—�S
Farm Status: _. r tt rl_ _
IDate of Inspection 14 11 NI I
Time of Inspection 1773t^i Use 24 hr. time
Total Time (in hours) Spent onReview
or Inspection (includes travel and processing)
Farm Name: �� S L 7 U County: _� .L.�?..� r r� ... T.... _. W.� .Q
Owner Name: S cL r a ��_. F--C S rl4. i v, _. Phone
Mailing Address: __ _� :_.. KC K
Onsite Representative: -2ss u Integrator:
Certified Operator. a v , t� Q +/� Operator Certification Number: Zo_j q ._
Location of"Farm:
Latitude Longitude �• �
❑ Not Operational Date Last Operated: _-
ti • r)-pe of Operation and Design Capacity
3 Number of Lagoons --I Holding Ponds � LEI Subsurface Drains Present
❑ Lagoon Area '. JE1 p S ray Field Area
General
I. Are there any butlers that need maintenance'umprovement? ❑ -Yes 9 No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
a. If discharge is observed, was the conveyance man-made? ❑ Yes fg No
b_ If discharge is observed, did it reach Surface Water? (If yes, notify MVQ) ❑ Yes ER No
c. If discharge is observed, what is the estimated flow: in gal/min? UJA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes RNo
1. Is there evidence of past discharge from any part of the operation? ❑ Yes 21No
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes E9 No
5. Does any part of the waste management system (ocher than laeoonvholding ponds) require ❑ Yes IN No
tr :iniem.snca!'improvement?

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after l/l/97)?
❑ Yes 19 No
❑ Yes ® No .
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ER No
Structures (Lagoons and/or Holding Ponds)
9. Is structural freeboard less than adequate? ❑ Yes ® No
Freeboard (fr): Lagoon I Lagoon 2 La_oon 3 Lagoon 4
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-I2 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structtfres lack adquate markers to identify start and stop pumping levels?
ZN'aste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type - be:OL- L
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?.
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities On1v
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Anir nal Waste Management Plan in any way?
72. Does record keeping need improvement?
23. Does facility require a follow-up visit by same ageacy?
24. Did ReviewerlInspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes
9 No
❑ Yes
K No
Z1 Yes
❑ No
Yes
No
❑ Yes
No
❑ Yes CKNo
El Yes IR No
❑ Yes E No
❑ Yes Q No
❑ Yes IN No
19 Yes ❑ No
Yes 9 No
❑ Yes R No
❑ Yes a INTO
Comments (refer to question R): Etplatn any YES 3risR err and/or and recommendations or anv, tithe, comn;ezts
Jse. orawtngs of 1Ku1iy-to better a lain situations use adntttonal a es as decess
r� (} . ,
'we�7a..-...s
1 Z- 1 r e- S e e-ci e- ,r c) s r o r cz S et- Y-t LLJ
Ct V' e- G- •' t- A.. G vt C J 'L-.r t J a• l ` e 1 O O
�.0 F, e ct S cL r Q k-. t ,rr v.J , c v e ✓'C �t r Y C i
.�ia+�.� S� �-�z i� S av r
t e��6Cj, j33�vrvGt 1�� Cl-9-i
c� v�tZt t .c v+.� b : v\ is h '� c-t l 1 des u •,.cl i�_ Y c
C �JiY CL
A - 4
' �' L c '�i � C C r � � G S k QI Yl t ✓� ,� � Q r '%'� � C'L C� CA Y-rL t t-'1�1 S CX. N^ L' j V4
j�qc�h. (rcrfr�� ►fir vie ce-rc L�r
Reviewer/InspectorName
Reviwer/Inspector Signature: ter 1 � 9
s �—
cc. Division of Water Qualify, Water Quality Secrion, Facility Assessment Unit 11/14/96

C.
I']
Site Requires Immediate Attentiogn.:
Facility No. "; 1 - 3 7 $'_
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS{SITE VISITATION RECORD
DATE: Y 2 b , 1995
Time: / a Y v
Farm Name/Owner: (Arf
a
'q-a 2 o V
/ cAffT l(
Mailing Address:
E'. v - '''
S &
, 211
County; 0 1 p 0 —
Integrator: � /; Phone:
On Site Representative: tl,,)-.- d jjt1 e r _ Phone: TO c- ov
Physical Address/Location: U e5 P- , i eY _. W7 —•E 1•e t PlU iv- N e _ a `l
rQyY` j r+ I'e J {
Type of Operation: Swine "`� Poultry Cattle
Design Capacity: 1gou s+�- Number of Animals on Site: vv s
DEM Certification Number: ACE DEav1 Certification Number: ACNEW
Latitude: _ 4 ° V - 0 I " Longitude: I � ° 0 X ' 3 a"" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: / Ft. _L_ Inches
Was any seepage observed from the lagoon(s)? Yes oro Was any erosion observed? 6�Por No
Is adequate land available for spray? (9 or No Is the cover crop adequate? Yes 00
Crop(s) being utilized: Nl,- 4 er
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?,�f_a or No
100 Feet from Wells? �e or No
Is the animal waste stockpiled within 100 Feet of USES Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar manmade 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)? or No
fAd itional Comments: ;, �[�s �� 'V_ ,'st,;F e,'xe cle,,y /.:_ere.
`0
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

"
Site Requires immediate Attention: �e
Facility No. '3 f - ?L7 5'
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANJIMAL FEEDLOT OPERATIONS ITE VISITATION RECORD
DATE: , 1995
- -- Time: i o"f 0
Farm Name/Owner: (.4-,r,-J % r f - a ? ©' l i c,*-"11(
Mailing Address: P
County:^ -
Integrator: -� _ Phone:
On Site Representative: r Phone: q10
Physical Address/Location: ;v e� K i t � Y 7 yl�;1'e t N t a
Type of Operation: Swine `� Poultry Cattle
Design Capacity: J,400 5 : -, Number of Animals on Site: _)Y00 5 s
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:__q - 5"6- ' ()q " Longitude: l �_ ° ' _5�1`` Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot r 25 year 24 hour storm event
(approximately 1 Foot ? inches) Yes or No Actual Freeboard: f Ft. G Inches
N'Vas anseepage observed from the lagoons ? Yes or i � Was an erosion observed?
Y p () (� Y or No
Is adequate land available for spray? OYes or No Is the cover crop adequate? Yes o �c
Crop(s) being utilized: y/4 ,, r
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?a� or No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orf9 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)?Sor No
Adtional Comments:
�G, r /./i-A 2111, rrj t2,.>FtY_ red'2 ^L" p: _ ',;(r
r
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.