310390_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: ,0 Co nee Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
nrrrrrir..�r r��r rur+-
Date of Visit: f Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact:
Tittle:
OnsiteRepresentative:
�r{^
r
M' TC_
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number: fl
Certification Number:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
We to Feeder
I
INon-Layer
I
Dairy Calf
eeder to Finish `2(C. D
2 [ It
Design
i Pao ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish I
I
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
10 L
Turke s
Turkey Poults
Other
Discharzes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[DNA ❑ NE
(DNA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - jDate of inspection: 3 / At
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [alTo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t t, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [:]No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate ManurelSludge 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rNq_❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesFn-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
No NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
ReAuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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
dNo ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
Page 2 of 3
21412015 Continued

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

Type of Visit: 0 rRoutine
pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
isit:
Reason for V0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: �� i Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: _ Title: Phone:
Onsite Representative: 97RAE� Integrator:
Certified Operator: Certification Number: I /A
Back-up Operator:
Location of Farm:
Wean to Finish
01
ILayer
Wean to Feeder
I
jNon-L.
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
reNo�n-L
Gilts
Boars
Other
Latitude:
Poults
Certification Number:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes To ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme al threat, notify DWR
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 ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /N�
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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 V) Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
CAW-MP20. Does the facility fail to have all components of the CAMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes rNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

• Facili Number: - Date of Inspection:
..,
_ 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
o ❑ NA ❑ NE
1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ AppIication Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
jo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yeso
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yeso
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility„ to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone( -
Reviewer/Inspector Signature:
Date:
Page 3 of 3 v 21412015

0
Type of Visit: (3 tRoutine
pliance Inspection V Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:q#D Arrival Time: Departure Timer County: i V Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: I I pC
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr P,oultr, Ca aci P,o ,
Dry Cow
Non -Dairy
Farrow to Finish I Layers
I
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets
Beef Brood Cow
Turke s
Other Turke Poults
Other I Other
Dischar es and Stream Impacts
l . is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes o ❑ NA ❑ NE
❑ Yes �7J ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: -9 jDate of Inspection: p
f3
Este Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[DNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: U�
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
0 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
ZNo
❑ 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 environmen I threat, notify DWR
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 yNNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �o.
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
0 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 YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 1 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24 Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes c ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes 7No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did facility fail to loss
❑ Yes 4No ❑ NA
Yes NA
❑ NE
the secure a phosphorus assessments (PLAT) certification?
❑ ❑
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No, ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA
❑ NE
f yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes � ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes dNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes do
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 7No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). .
Reviewer/Inspector Name:
Phone
d
Reviewer/inspector Signature:
Date:
1
Page 3 of 3
2/4/ 01

Type of Visit: QrCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Z n Departure Time: County: Q(f Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: 5TE VEKJ W/ e L4.r k bls Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: j 1 Z- 9
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D , P.oult . Ca aci Pao ,
La ers
Non -La ers
Pullets
Turke s
Turkey Poults
Other
D Cow
Farrow to Feeder
Farrow to Finish
Non -Da'
Beef Stocker
Gilts
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [2/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ffN ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ]Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

FaciliNumber: jDate of Ins ection: 2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
LA
Observed Freeboard (in): :—
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes M No 0 NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes DNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
Waste ADnlleatiOD
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes WNo ❑ 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 E�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [Yes ❑ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes WNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ 4No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E�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 [7f No [DNA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall lnspectiorw/ ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 4 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: ill Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes FENo D NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [—]Yes O/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[21No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[JNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ YesgNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional ttaizes as necessarv).
IS) 126wav VC
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
f,e &4ZWT� J(,16
4
Phone:
Date:
21412011

Type of Visit: Q Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (O Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O_ Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:.yPtz!�j Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: S1 wtj PLUXAMIM)
Certified Operator:
Phone:
Integrator: C
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
Layer Dairy Cow
C►urrent
Pop.
Wean to Feeder
Nin-Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
airy Heifer
Desie Dry Cow
D , P,ouI C•_a aci P,o Non -Dairy
Farrow to Finish
ILavers
I Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes CZ /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

/L
[Facility Number: - Date of Inspection: 5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes d&o ❑ NA ❑ NE
r a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ( No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes No ❑ NA ❑ NE
mamtenance or Improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18, Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [MK/]o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[—]Yes 7No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
❑ Yes �o ❑ NA [3 NE
[:]Yes YNo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: < I -,Zqo IDate of Insnection: / 9
24. Did the facility fail to calibrate waste application equipment as required by the pernv ? ❑Yes �] ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �/No ❑ NA ❑ NE
0.
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
12<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
DIN o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[jKo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
C�/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
L a No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
Info ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ Nc ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o [3NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I b` 3 D I
Date: s
21412 11

J�`SF.b SrgT�S
Yz
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
o
REGION 4
ATLANTA FEDERAL CENTER
61 FORSYTH STREET
1107
ATLANTA, GEORGIA 30303-8960
MAR 0 S 2013
CERTIFIED MAIL 7012 1010 0001 8097 3741
RETURN RECEIPT REQUESTED
Mr. Stephen Williamson
Earth Right Farms Inc. .
141- E. Wards Bridge Road,
Kenansville, North Carolina 28349
Re: Earth Right Farms
Animal Waste State Permit No. AWS310390
Dear Mr. Williamson:
On September 20, 2012, the U.S. Environmental Protection Agency, Region 4 and the North Carolina
Department of Environment and Natural Resources performed a Compliance Evaluation Inspection (CEI) on
the Earth Right Farms (Facility). The results of the EPA's CEI are summarized in the enclosed report.
The EPA's participation in this inspection was to evaluate the Facility's compliance with the requirements of
Section 402 of the Clean Water Act, 33 U.S.C. § 1342, and the regulations promulgated thereunder at 40
Code of Federal Regulations Part 122.23.
Enclosed are two documents, the U.S. EPA Small. Business Resources Information Sheet and the Clean East
Management Plans, to assist you in understanding the compliance assistance resources and tools available to
you.
If you have specific questions or need additional information, please contact Mr. Don Joe at
[phone].
Sincerely,
Stacey L. Bouma, Chief
Stormwater & Residuals Enforcement Section
Clean Water Enforcement Branch
Enclosures ECEIVE
MAR 1 1 2913
cc: Mr. John Fennel
North Carolina Department of Environment and Natural Resources, i-CZwc
Mr. Keith Larick
North Carolina. Department of Environment and Natural Resources
Internet Address (URL) + http://www.epa.gov
Recycled/Recyclable + Printed with Vegetable Oil Based Inks on Recycled Paper (Minimum 30% Postconsumer)

United States Environmental Protection Agency
Washington, D.C. 20460
Water Compliance Inspection Report
Section A: National Data System Coding i.e., PCS
Transaction Code NPDES
yrlmolday Inspection Type Inspector Fac Type
N
2012109/20 = T 3
Remarks
Inspection Work Days Facility Self -Monitoring Evaluation Rating Bl CIA Reserved
Section B: Facility Data
Name and Location of Facility Inspected
Entry Time/Date
Permit Effective Date
Earth Right Farms
10:35 AM
10/01/2009
Exit Time/Date
Permit Expiration Date
1450 East Wards Bridge Road
Kenansville, North Carolina 28349
12:00 PM
09130/2014
Name(s) of On -Site Representativeis)/Tide(s}IPhone and Fax Numbers)
Stephen Williamson, Operator, (910tl 289-18599
Other Facility Data (e.g,, SIC NAICS, and other
descriptive infomtah'on)
Brent Mitchell, Technical Specialist
Environmental Consultant
NAICS: 11221
Goldsboro Hog Farms — Goldsboro Milling
Kevin Rowland, Inspector
N.C. Department of Environment and Natural
Name. Address of Responsible Official/Tide/Phone and Fax Number
Earth Right Farms Inc.
Mr. Stephen Williamson, Operator
Resources
Wilmington, NC.
1450 East Wards Bridge Road
Kenansville, North Carolina 28349
[phone]
Section C: Areas Evaluated During Inspection Check only those areas evaluated
Permit
Self -Monitoring Program
Pretreatment MS4
X
Records/Reports
Compliance Schedules
Pollution Prevention
X
Facility Site Review
Laboratory
Stormwater
X
Effluent/Receiving Waters
Operations & Maintenance
Combined Sewer Overflow
ESanitary
Flow Measurement
Sludge Handling/Disposal
Sewer Overflow
Section D. Summary of Findings/Comments
Attach additional sheets of narrative and checklists, including Single Event Violation codes, as necessa
SEV Codes SEV Description
110000
00000
0000❑
0
Name(s) and Signature(s) of Inspector(s)
Agency/Office/Phone and Fax Numbers
Date
r \
USEPA Region 4/Water Protection Division
Clean Water Enforcement Brandy
�� D Q
O
Stormwater & Residuals Enfonxment Section
Don M Joe, Environmental Engin
Ph: [phone] Fax: [phone]
Signature of Management 0 A Reviewer
Agency/Off€celPhone and Fax Numbers
Date
USEPA Region 4/Water Protection Division
31111�
Clean Water Enforcement Branch
Stormwater & Residuals Enforcement Section
Stacey L. Bouma, Chief
Ph: [phone] Fax: [phone]
EPA Form 3WO-3 (Raw 1-06) Previow edt=9 are obsolete.

NPDES CAFO Water Compliance Inspection Report
Date 09/20/2012 Entry Time: 10:35 AM
Weather Conditions Clear sky
State Inspector(s) Kevin Rowland
Facility Name Earth Right Farms
Latitude/Longitude N 35.023330 W 77.87920
Type of Operation Swine
Number of Animals 2,160
Permitted
Number of Animals in Confinement. 2,100 X 45 days or more
Animals have direct contact with Waters X no ❑ yes, explain
Nearest Waters 0.303(d) listed, for
25-year, 24 hour rainfall amount for this location: 7.5 inches
include source
Description of Facility
The Earth Right Farms has a total of three (3) swine houses that contained approximately 2,100
feeders to finish swine during the time of this inspection. Each house can hold a maximum of
720 hogs.
7Per"mi,tber AWS310390 ❑individual X•general
X co available on site
.10/01 /2009
Expiration Date 09/30/2014
Number of Animals the Facility is permitted for 2,160
Compliance Schedule X no 0 yes, provide a brief description

Facility has NMP X yes X copy available on site
❑ copy maintained at farm office at another location.
❑ no ❑ the Facility has a nutrient budget
❑ the Facility has an environmental management plan
Includes Maps of Production and Land Application Areas X yes ❑ no
RECORD4. KEEPING
Inspections of Waste Storage System
X
yes
❑
no
❑
some, explain
Liquid Systems, Freeboard Records
X
❑
yes
not
❑ no ❑ some, explain
a liquid system
Inspection of Storm Water Controls
X
yes
❑
no
❑
some, explain
Rainfall
X
yes
❑
no
❑
some, explain
Records of Manure Transferred Off Site
X
yes
❑
no
❑
some, explain As needed
Records of Land Application of Manure
X
yes
❑
no
❑
some, explain
Maintenance Records
i.e. equipment calibrations
X yes
❑
no
❑
some, explain
Annual Reports
X
yes
❑
no
❑
some, explain
Emergency Response Plan
X
yes
❑
no
Soil Samoleis
Manure Samples
X yes ❑ no ❑ some, explain
X yes ❑ no ❑ some, explain
4

Manure Storage Structure(s)
❑ holding pond ❑ clay lined ❑ synthetic lining
X lagoon ❑ aerobic digestion X anaerobic digestion
X clay lined ' ❑ synthetic lining
❑
concrete structure
❑
under house structure
❑
manure pack house
❑
manure lot
❑
composting
❑
other
scription of Storage
s
❑ concrete slab
❑ tarp/cover
The facility has one lagoon and land applies to seven (7) fields of Bermuda hay from March to
September, and small grain from September to May. The total available acres for land application
are 101.21. Facility applied the lagoon wastewater with honey wagon.
Designed to NRCS or.State Required Standards . X yes
❑ no
❑ do not know
Visual Inspection of Structure
Structure(s) appears to be maintained to state standards
X
yes
❑ no ❑ concerns, explain
Structure(s) appears to be stable
X
yes
❑ no Q concerns, explain
Rain gauge installed and maintained
X
yes
❑ no ❑ monitor rainfall by
Structure(s) maintain liquid waste
X
yes
❑ no
Banks are maintained
X
yes
❑ no
Marker is present to gauge freeboard
X
yes
❑ no
Adequate freeboard based on NMP or state standards
X
yes
❑ no
Comments
The banks of the lagoon are maintained well, mowed, and do' not have
any overgrown vegetation.
The lagoon freeboard measurement was over 24 inches during the inspection.
5

MANURE7. MANAGEMENT (UTILIZATION
. NUTRIENTS
Manure Transferred Off -Site' ❑ yes
X no ❑_ some, explain
The Facility is following state approved X yes
❑ no ❑ some, explain
protocols for transfer of manure
NMP Calculated Application Rates and X yes
❑ no
Areas for Application
-
Manure is Land Applied on Farm X yes
❑ no ❑ some, explain
Description of Land Application System
The facility has seven (7) land application fields with total of 101.21 acres available for land
application (Bermuda hay from March to September, and small grain from September to May).
Facility applied the lagoon wastewater with honey wagon.
The Facility has Adequate Land Available
X yes ❑ no
Facility has a schedule for Land Application and is
X yes ❑ no ❑ some, explain
following the schedule
Land apply as needed
Facility has appropriate setbacks and buffers
X yes ❑ no ❑ some, explain
There are wooded buffers between the spray
fields and water bodies.
Visual Inspection of Land Application Areas
Field
Crop Growing
BMPs ! Buffers
Concerns
Identification
#1
Bermuda hay/Small
none
Grains
#2
Bermuda hay/Small
none
Grains
#3
Bermuda hay/Small
none
Grains
#4
Bermuda hay/Small
none
Grains
#5
Bermuda hay/Small
none
Grains
#6
Bermuda hay/Small
none
Grains
#7
Bermuda hay/Small
none
Grains

Mortality Management According to the NMP
❑ burial
❑ incineration
X rendering
❑ composting
NMP gives specifies location for mortality management ❑ yes ❑ no NA
NMP specifies management required ❑ yes '❑ no NA
Visual Inspection of Mortality Site
Mortality Management On Site
❑ burial
-❑ incineration
X rendering
❑ composting
Facility is Managing Mortality According to the NMP X yes ❑ no
Comments
A dead animal box located near the site exittentry
NMP addresses the storage, handling and manaqement of all chemicals X yes ❑ no
Chemicals stored on site
❑
fertilizer
❑
herbicides
❑
pesticides
X
cleaning supplies
❑
fuel
❑
veterinary,
❑
other
micals Any unused chemical will return to supplier
e.
7

Visual Inspection of Chemical Storage
Facility is managing chemicals according to the X yes ❑ no
NMP
Comments
10. OTHER WASTE GENERATED
Waste Generated Stora a Disposal
NA
Comments
Has the Facility had a Discharge? X no
❑ yes ❑ date
❑ reported to the State and/or EPA
❑ description of discharge
❑ sampling, description
Description of Actions taken NA
No discharge observed during the inspection.
Exit Time 12:00 PM

r
ice'. �„"�- ` ... i "�,`.'��+.�1:-- •v� -�..
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00 =•b. _
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r ^�+-f'� T•IpS•.!a':.'' ;.' i _vim ..+,.

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-11

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7V4

3
Type of Visit: Q Compliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance
(J Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: J 7i Arrival Time: / Q 3a Departure Time: �County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: :5 F��E ji �1 "LLLUMA56
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Deslgn Current
Swine Capacity Pvp.
Wean to Finish
Design Current Design
Wet Poultry Capacity Pop. C►attic Capacity
Layer Dairy Cow
C*urrent
Pop.
Wean to Feeder
I
INon-Layer
I Dairy Calf
yt
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
h
1r6o
Dairy Heifer
Design C►urrent Dry Cow
Daci_ P,o , Non -Dairy
ILayers Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turkeys
Turkey Poutts
Other
ff
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[:]NA
ONE
❑ Yes
o
❑ NA
❑ NE
[:]Yes
WNo
❑ NA
❑ NE
Page I of 3
21412011 Continued

Facili •Number: jDate of Inspection -
Waste Collection & Treatment J
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
Identifier:
Structure 1
UALJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
3
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
i
❑ Yes 1 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes � o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s).
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EjlNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
In No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F31No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
i
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili ,Number: jDate of Inspection: ? j•v
r
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes []f /No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1� No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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:
❑ Yes
❑ Yes
❑ Yes
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0No ❑NA ❑NE
No ❑ NA ❑ NE
EJ/No
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
E/No
❑ NA
❑ NE
Iommments (refer,to question #):,Explain any YES answers and/or any additional recommendations or;any other comments K YI
Use°drawin s of fa6litv to better ex lain situations use additional pages as necessary)...
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I ! I
Date: /l
21412011

d
Division of Water Quality = g
FaCthty Number - Q Division of Soil and V4'ater Conservation
- Qdtlie
rz.Agen y
Type of Visit (�Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0/�Other ❑ Denied Access
Date of Visit: t Arrival Time: ® Departure Time: �-1 t S County: W P 1' Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 1��) ��,� �Tiittle�:
On site Representative: 51-Vilen) kktLk rt1 �'S"J
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e [--]' [—]" Longitude: E-1 o
Desi n Current Design Curreutr Design Current g , .
Ca" ace Pa ulation Wet Poul`t Ca aci Po dlarion " Cattle :::Ga aci P.o ulation , p. _ .0 p tJ _.. P .= "' p ty P�;,
.-,. r_
❑ Wean to Finish ID Layer F ❑ Dairy Cow
❑ Wean to Feeder
' ❑ Non -Layer
❑ Dairy Calf
Feeder to Finish
*`m -
-; ❑- Dairy Heifer
❑ Farrow to Wean
_
ry -
❑ Dry Cow
,pry Poul
❑ Farrow
❑ Non-Dai
to Feeder
❑ Farrow to Finish
❑ Beef Stocker
a ❑ Gilts
El Beef Feeder
❑ Boars
» ❑ Beef Brood Co
Other ai, n.»..e.n.a,.,Poa�:
KF"Y•:.kY!:.sss�o.z,.:a®,.
u^a w'�y?Stre&-
»�
-
.
❑ Other
. ._'
:.
.. r
>V ofStru um erx ctures:LJ
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 V/No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
❑ NE
❑ Yes
El Yes
� ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12/28/04 'Continued

Facility Number: — b Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes WNo ❑ 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures tack adequate markers as required by the permit? ❑ Yes o ElNA ElNE
(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 o ❑ 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 W indow ❑ 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?
0 es
[3No
[I 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
[I NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
,
ld No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Pji4o
❑ NA
❑ NE
-Comments (refer to question #) -:Explain any YES answers andl`or any :recommendations or any other�.comments ¢g a,
Use. drawzngs of facility to ;better "Oiplain 'situations (use additional pages as necessary) � -
0 A511,00
Reviewer/inspector Name
Phone d 1 6 —
Reviewer/Inspector Signature:
Date: 3
Page 2 of 3 12128104 ' Continued

4
Facility Number: p Date of Inspection
Required Records & Documents VNo
�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ElNA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � o ❑ NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El � ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VT� ElNA [INE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYes 0 ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes WN ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes LJ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 0 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 WNo ❑ 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 7�4.
/o ❑ NA ❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes YNo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Divispon of Water Quality
f„. 1.
Fac 14y timber g k 3 O QaDiviston of Soil and Water Cons "ry
DaOtherAgency.-
Type of Visit C0 piiance inspection Q Operation Review O Structure Evaluation O Technical Assis=Acc'ess
Reason for Visit C Routine O Complaint 0 Follow up Q Referral 0 Emergency O Other ❑ Deni
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:. SiEiE Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = Oil Longitude: [--I o ❑, a
r
Design Current ` nDesrgri Eurrent: Design Current
d swine,
labCapPupur it aci Po ulaion
�latio R _
❑ Wean to Finish 10 Layer ❑ Dairy Cow
❑ Wean to Feeder
I JO Non -La er ❑ Dairy Calf.
Feeder to Finish
{r ar^ ❑ Heifer
a-i Dairy
3.
W
[] Farrow to Wean
t�
� D Cow
❑
Dry�Poultry'
❑Farrow
�.� � � _, �
-" ❑Non
to Feeder
�
❑ Farrow to Finish
-Dairy
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers ❑ Beef Feeder
V❑ Boars
❑ Pullets
❑Beef Brood Cowl
��
❑ Turkeys
�ther*��� ❑Turke Poults x
10 Other I ❑ Other Number of Structures:-
�_
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
ONE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
M<o
❑ NA
❑ NE
❑ Yes
Ld No
❑ NA
❑ NE
12128104 Continued

Facility Number: ( — Date of Inspection y /
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): oZ'%
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 4o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VJ'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes eNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No [I NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes To ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or to 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
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
7IJ El NA El NE
LI No ❑ NA ❑ NE
eN El NA ❑ NE
7�N ❑NA El
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers mWor anyr`ecomimend'ations or'anv otherrcomiments ' Lam.
Use drawings ofofacility to,better explain situations (use:additional pages as necessary)
n,
k. <= ? P Y d C t✓a 2.P G� StN c,6 tc .os
Reviewer/Inspector Name Phone: �� �-� — 3
�'k
Reviewer/Inspector Signature: Date: CIA-
Page 2 of 3 1 12128104 Continued

Facility Number: 5 — 39v Date of Inspection
Required Records & Documents ,,��,,//
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes LlNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes., check ❑ Yes CNo ❑ NA ❑ NE
the appropriate box. ❑ ❑ ❑ ❑ ❑
WUP Checklists Design Maps Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ENo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El
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
� o
❑ NA
ElNE
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?
E Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
L✓i 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
El 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
Ef No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JO No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

31 M. 3qO
L
f Visit 0 C mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: d Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: M
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = i = Longitude: = o = d
Design C►urgent
Design C•ugrent
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Gilts
ElNon-Layers
El Beef Feeder
❑ Boars
❑ Putlets
❑ Beef Brood Co
ElTurkeys—
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream [moacts
I. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
VNNo
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
❑ NA
❑ NE
other than from a discharge?
Page 2 of 3
12128104
Continued

Facility Number: '31 — l O Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
El Yes ❑ No ❑ NA ❑ NE
SttructureJ 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: LA Cam✓
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 23
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 6No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes E�No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �Zo
�[I NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L/J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes P44/0 ❑ 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
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P�No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ET�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[N
No
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑
❑ NA
❑ NE
1�xE o -ra Cur S G-0 AGrAW .
Reviewer/inspector Name 1 o Phone: -73 TV
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Vontinued

facility Number: — TO] Date of Inspection =9 104
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WtTp ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes 4 ❑ NA ❑ NE
❑ y 7No ❑ NA ❑ NE
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 l"
Rain Inspections( ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
1 No
E�'N
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L/J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
d o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
LJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2 No
❑ 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
El Yes
Wo
❑ 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
El Yes
,�j
L� No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo❑ NA
❑ NE
Additionid Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number 3
0 Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit QlC pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: •-1 Arrival Time: 0 G Departure Time: County:�N Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: STeuE Ljj_k.L aQ Z_6T Integrator:
Certified Operator: Operator Certification Number:
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
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = 0 0 4 = Longitude: = ° = 1 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
T. ❑ La er
❑ Non -La ez
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
ElTurke Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: ED
Discharzes & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes d o El NA El NE
ElYes 7o ❑ NA ❑ NE
12128104 Continued

'F"acility Number: — Date of Inspection o
Waste Collection & Treatment
4. Is storage capacity structural plus storm storage plus heavy rainfall less than adequate?
g ty( P P ) q
IJ Yes
o ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (_ice
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 11 J
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
YNo ❑ 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures 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 ❑ 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 [I/No ❑ NA [I NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
❑/ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
'o
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
Zo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes Zo
❑ NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes ❑ 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):
S ttUC CAu.E� yt1 �f j� ° atiEEiJ �d1� VOW, . S 66 REAJI t' r 4#.4Slr
IjJ(6CPA
�� g� �Il (3�.t,�ti.1 ,S'ra P +��"C�4rr ✓ v�E is
Reviewer/Inspector Name ,iVQ 1� (t- Phone: 774
" 730.
Reviewer/Inspector Signature: Date: 18 p$
1 .HMO/AI n__.�•_____J

I
Facility Number: — jup Date of Inspection 8
t '
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
ElYes
CJ N
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
,�,�
O No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
'
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z40
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
o
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
]No
El 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 DINA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LRYo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LEI Igo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
u No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Additional Comments=and/or Drawings: _ .
Page 3 of 3 12128104

Facility Number
0 Division of Water Quality
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit ('j ,. Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit c(J Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S 1 0 -7 Arrival Time: g; S Departure Time: County: Dt'PLZiV Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
/ Title: Phone No:
Onsite Representative: _fihmeK I,/ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish 01),
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[]Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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?
Longitude:
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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
�N
❑NA
El NE
El Yes
No
❑ NA
❑ NE
12128104 Continued

u
Facility Number: -) —S 6 Date of Inspection �•(
Waste Collection & Treatment �,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes LQ 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: (}9Gwa/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
E 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
Z No ❑ NA ❑ NE
through a waste management or closure plan?
ental threat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envi7yes
7. Do any of the structures need maintenance or improvement?
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
ENo ❑ 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
dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E2"No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes
DNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
DIN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ YesL__d__,,//No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
❑ NE
18. is there a lack of property operating waste application equipment?
El Yes
Zo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
7.) D3dtL WAS IiAr S-*m& CUramW- 04E1b 'o R6PiAa nPgdZL A$JP Q,$7A&,.UO
G luasS coves
uli +yc {R.EE e0A0V 7/,/0 -7 -?fit-���7 ' CA&l f�NA1 6PLa g� , "Fr M6S146 E . MEf9 rd
a9-riS� FU Cd Y 6( 914'V66 A lO e,4
Reviewer/Inspector Name G (� Phone: Q/Q�? q1., - ­2T. 8�
Reviewer/Inspector Signature: Date: . / O

Facility Number: Date of Inspection
o �
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping neeZeekly
rovement? If yes, check the appropriate box below.
❑ Waste Application Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Rainfall ❑ Stocking
❑ Yes LQ No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
0/yes ❑ No ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
❑ 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 ENo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�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? [ryes ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 9No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No E 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?
Comments and/or Drawings:
❑ Yes
EWo
❑ NA
❑ NE
❑ Yes
0<0
❑ NA
❑ NE
❑ Yes LI No ❑ NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
[]Yes 2<0
❑ Yes U✓ No
❑ NA ❑ NE
El NA ❑NE
12128104

Facility Number �
( Division of Water Quality
0 Division of Soil and Water Conservation
0.Other Agency
Type of Visit Co liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ,3 I 6Io Arrival Time: ® Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J ^ rg Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
�o
Latitude:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
=" Longitude: =1 c =' =
Design Current Design: Current-., Design Current
,-Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population`,'
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
g1.4 602oa6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
�.. ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number.of Structures :=� e
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 l of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
[I NE
❑ Yes
❑Yes
❑NA
VN
❑NE
ElYes
h No ❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — Date of Inspection Faf I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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: (J4 G
Spillway?:
Designed Freeboard (in): jet ,S _
Observed Freeboard (in): a-g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo ❑ NA
❑ 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
o ❑ 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
2 Yes ❑ No ❑ NA ❑ NE
❑ Yes o
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ 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 Soi
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) J & 0 & k*" n L H)
13. Soil type(s) RL1 WOJO G-OL Oslja" AcM"UML(,E
❑NA El NE
❑ NA ❑ NE
l4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [L No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes WNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes V No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 7No
do El NA El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ 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):
�.) 1�urvtP CIE IC03 FS+cT..1 & aN 0 Iq r— c_.o N *ct-.oS
ad.) U P DATE G+Qe q z*x o F06,^n.
LaC'1"T AND i�-ECZC�PT 'Po r1 E SCUT To O wci2 -S'rare FZK_s AO j C-de y 6P
U? Dare C-azp '?sL� � NFrJ r,IRSr NA2�EST
Reviewer/Inspector Name ,rot.tN �, � Phone: � qiO 'Jg(o — 7A,��
Reviewer/Inspector Signature: Date: 'S q/o(.
Fage L of .S 1 ai,Zaiv4 ton anuea

tF
i•
.
r
1
, r
1

I
1
t{ ,�
Facility Number: 3 — �gp Date of Inspection t� 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes eNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9�No ❑ NA ❑ NE
the appropriate box. ❑ WUp [l Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. EkVe's ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ kly Freeboard ElWaste Analysis ElSoil Analysis [IWaste Transfers ❑ Annual Certification
[IRainfall [IStocking Wrop Yield ❑ 120 Minute Inspections ❑ Montbly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[6N
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LCNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
7NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2No
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Ek<A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E;o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
��
LKNo
❑ 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
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2*f4o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Id'hio
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Z Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit PfRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 Arrival Time: IDeparture Time: County: GZ I Region:
Farm Name: _ CF�T� _ 1�i2A'! Owner Email:
Owner Name:/S Z.LL �/ �+�� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:GQzvx�sIntegrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 6 = 6f Longitude: = ° = 6 =
is
Design Current
Swine Ca¢p ty Pop la 'on
❑ Wean to Finish
Design Current
Wet Poultry Capacity Populati©n _..
❑ Layer I_ _ _I
Cattle
Design Current
Ca, aci Population
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish I V&O V
El Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑Non -La Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
JE1 Other
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: `— I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 10 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
x No
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ YesNo
El NA
El NE
other than from a discharge?
//
12128104
Continued

Facility Number. — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate?
a. If yes, is waste level into the structural freeboard?
S) cture I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [/No
❑ Yes ❑ No
Structure 5
El NA El NE
El NA El NE
Structure 6
❑ Yes No ElNA ElNE
. 0
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes VNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA XNE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
/VNo
eRryes ❑ 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 ONo
❑ NA
❑ NE
Comments;(reler to questton: # Exjtatn any YES` answerskandloranv recommendations or QuEr any other comments.
+UseXdrawmgskaf factlttyto better explain sthtahons ,(use addtttonal pages as necessary):
.
d S�%/�i (/��l�il-Z,t f S� L G' �/�.�i✓7 ...L�i� /`Z.L�Lt�%5 . �/ �i O ''C/L�
/DD
.✓ ,g�•�•+
Y
Reviewer/Inspector Name .0 Phone: o —SAC,,
Reviewer/Inspector Signature: Date: �1 0
12128104 Continued

Facility Number: — Date of Inspection I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
l/J No
❑ NA
❑ NE
the appropirate box. El❑ Design El El WUP ❑ Checklists
!!!!!
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 X 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
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ezNo
VNo
❑ 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
El 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
#ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:'
D-D
12128104

IType of Visit JFCompliance Inspection O Operation Review O Lagoon Evaluation i
Reason for Visit (YRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit:
)IlPermitted M Certified © Conditionally Certified 0 Registered
Farm Name: ...�6.0.7ZI Fal.11 21................_....
�l�Sor..... .......... _.__... __........ __ ....... _........
.N, L%hng Address:
OTime: ,
Not Operational O Below Threshold
Date Last Operated or Above Threshold: .........................
County:
rfR!�.._ ...................... ......_.. .
-Phone Nord.'..
Facility Contact: .._........ .......... .............
r�p....._..... __.._-Title: Phone No:
...... }) _._... _,.�.... .... ...
Onsite Representative: ,�5.�,SC1r._ai1 L'fJ�lL..„ ._ .. Integrator:jf�.
Certified Operator:
Location of Farm:
Operator Certification Number..,......_ ....._ ...__—•-•
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 1 64 Longitude • 1 «
DisigA ,: Cnrient = Dig'' Cilrfeilt > ?
�:Ca act
,
Po�`ula&on Poultry`_ _ Ca aciE
Po nlatioli: _
❑ Wean to Feeder
= [] Layer
,,:Cantle
' ❑ Dairy
Feeder to Finish,
❑Non -Layer
a ; ❑Non -Da
Farrow to Wean
Farrow to Feeder
❑ Other'
;
Farrow to Finish
, 3
a "' '
�.-- � Total Designi CapaclEr
❑ Gilts
.
Boars
w �'TotaUSSLVV
- x _. _..-.�"..- ,.- ._.-..... _. _
- ___- .. - u..: :-_ ,_`.^.....�� .. .. .•.'.]Gtt-- .-...`�..-:.,,,_ a `,_"'-� .-, i.,
s Nniuber of Lagoozis
� .� �`
Discharges & Stream Imparts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaumin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
w � J
❑ Yes P No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 4ET&o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Coilection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Stryclure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ._2. ..... ............ ....._._....._............_............-•-- .....
Freeboard (inches): `3 %
12112103 Continued

1F'aeikty Number..j — o Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes d No
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? ❑ Yes Z`No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes Z No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ['2'No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ZNo
11. is there evidence of over application? If yes, check the appropriate box below. 1014fes jjNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ,Copper and/or Zinc
12. Crop type ) , 4�r6qF49/)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ;2�No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 2'f10
b) Does the facility need a wettable acre determination? ❑ Yes ONo
c) This facility is pended for a wettable acre determination? ❑ Yes 13"No
15. Does the receiving crop need improvement? Oyes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ;! No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ;3,140
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ZNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 01Vo
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 ZNo
Air Quality representative immediately.
Comdeertts ( er to' gaeshon #} Explarq y AYES answers`'`aadllor a rye= commesfdatioas orrany uth_ er com_ en rNa ,
Use drawings of facility to better explaw sttnahoa`s. (use'addibonal gages as necessary} ❑ d co -p F Notes
Fiel N,
Copy anal
x M" k
y-
--M� s.
1!elil -2, /'eqoi/� ' o .3 7��3
ey74
rvl iS Qi'e e 7Z
G��sr 0'0 e
4�1�1
Peed al -ea 1-2O e; in ;0i�e�c�aZ
/
Al�e ccr 7Cc GIP�y ���/lfa�`e .�Pr-rnac��
moo ; Gdd�� moo/ off' CQcc 1 61 Qreaa s.
c�
6,
ReviewerAnspector Name U4
Reviewer/Inspector Signature: eet—__ Date: $� d
12112103 Continued

)Fadlity Number:
Renuired Records & Documents
Date of Inspection
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
8 No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
ZNo
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
fTNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
QNo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
O�No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ff No
28.
Does facility require a follow-up visit by same agency?
Yes
M`No�
29.
Were anadditional problems noted which cause noncompliance of the Certified AWMP?
Y P P
0 Yes
❑
❑ No
NPDES Permitted )Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
ENo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. .
12112103

* . _
Type of Visit Q�Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Bate of Visit: % Time:
Facility Number
10 Not O erational 0 Below Threshold
Of Permitted ©Certi/fiieed, © Conditionally Certified © Registered Date Last Operat r Above Threshold:
Farm Name: � 7 _ County Z!W
Owner Name:
Mailing Address:
Phone No:
Facility Contact: CM A161 Title: Phone No:
OnsiteRepresentative: �t��n% I�f4JFll �C Integrator: ODDS
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' • u Longitude ' •
Design : Cii
i.
d Swtne.:= Ga aicity Po i
❑ Wean to Feeder
Des"in =Current
:.
Subsurface Drains Present
No Liquid Waste Managep
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 1 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
rav Field Area
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure b
In
�mra - Mm

} Facility Number: .. Date of Inspection: /2 ao 2
v
Additional Comments,an&or'Drawings
���: � OG�dc[Ju/� 25` 7 ^/,pclCTfD y9�f ,��G.�O�✓�L ` �on��inzs 4
Slpi� A- �zF��►:1 S,. , j �� t�e�r►PC..2ign�,�. �Y:SP�EC
r Q _
ZTi`f C� df�5 g;9e-
lry� ,� ff ass o e! (,z�SJ X/- 50
� d
�-��7 A/44FO /V�PFC�Zv�/ o
/E AG D"7'1�n}
vn1�y �pr✓GE/�N�/✓G— a��G ��y���?�5 Q.�/ T,�
AVCP -7-
G
/2
� % v f7�fJf �DmF :Sln/9LG � �✓�S���l�lti�7�Q LF fVo T
�D
4/30/97

f k,4_�,.
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit o Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Late of Visit: t� Z Time. -
Permitted ❑ CertiGfied E3 Conditionally Certified © Registered Date Last OperattM or Above Threshold:
Farm Name: .. &M Count: 40WPd(z^)
Owner Name: 4.�D�F'iJ ,5C Doi' Phone No:
Mailing Address:
Facility Conta Title: Phone No:
Oi 1l 0p7/ 6OnsitCeWePresinstive:
� L f� '�-i i fs 7�1/� _ Integrator: DeIJSiP17
Certified Operator: Operator Certification Number:
Location of Farm:
Pf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' " Longitude 0
- Design G,
Swine': ; Ca...` P.._.
❑ Wean to Feeder
3�1(PTFeeder to Finish 12(1�
U Farrow to Feeder
❑ Farrow to Finish
r'' ❑ Gilts
❑ Boars
Design Cnr
❑ Layer
I
I
❑ Dairy
❑ Non -Layer
I
I
Irq
❑ Non -Dairy
❑ Other
Subsurface
No Liquid'
Total' SS
Present H Lagoon Area SArav_Field Area
lanagement System 1 A
Discharges & 5tream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? t gExcessive Ponc
12. Crop type nFQM L,f ()A ( 1"fAq ) % fA
13. Do the receiving crops differ with those designated in the Certifi
14. a) Does the facility lack adequate acreage for land application? '
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re fired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes A No
❑ Yes ['No
❑ Yes No
❑ Yes No
❑ Yes /NO
❑ Yes A No
PNo
MAIM
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes T' No
❑ Yes VNo
❑ Yes No
❑ Yes No
❑ Yes VNo
❑ Yes �No
❑ Yes No
❑ Yes No
Yes �No
❑ Yes VNo
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
m
Com rents irefert64' uesttnn # Ex Ita[n'any YES snswers an�/vr soy recomm�ndations,or any_ather oommeiies. _- -
Use.drawt%s of facility to better explain situaho Ease'addtnonal pages :as necessary) - ❑Field Conv❑ l final Notes^
Ar�o2.
e,017re A,✓,o Gook � cos
G�j� Q�/ i7G�. !`2F(,�js�, /"CFC}��IS/Jl�iYx✓Gyt,rj ��-n/�F,O /��D/t't I7 �� �L,se
LOW
Reviewer/Inspector Name
_.
Reviewer/Inspector Signature: Date: / dz
05103101 Continued

t
Facility Dumber: — Date of Inspection
Qdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes �No
❑ Yes XINO
❑ Yes 2 No
❑ Yes X
o
❑ Yes ❑ No
;_additional Comments and/or`Drawinits: _ -
��
"�5
ox", - 5 MA
05103101

t.
= Q�Dther`Agency, - r
Type of Visit Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number G Date or Visit: Z Time: / ' e�
Q Not Operatio2d Q Below Threshold
*Ibermitted 0 CertifiyO 0 Conditionally Certified © Registered Date Last Operated o Above Threshold: ......... .......
. Farm Name:........L?......11y w1County:......... .................
..--......
OwnerName: ........... ..........................-.-.........-.-............."..........
.........
.........
Phone No:
Facility Contact: .......................................Jl �C1�...... Title: .. Phone No:.......... .........................................
MailingAddress: ................ .................................................-.........- ..... ....-------...
Onsite Representative: •,-_rd� ( •��.. �[9/%� 1./•�(-integrator:.•.• ,. (.±.....,`�...
... ...-
Certified Operator: ................................................... ............................................................. Operator Certification Number: ..........................................
Location' of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Worse Latitude �'
��"L6
Longitude
�• �s ���
Design - Current -
Design
. ,Current.- :
Design Current
Swine °Ca aci Population Poultry
Capacity
Population = Cattle. ;
-
Capacity-,;.papd„ti6„ ,
❑ Wean to Feeder
�c Feeder to Finish
(pO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I I I❑Dairy
❑ Non -Layer I I ❑ Non-Dair
❑ Other I I
- . .
Total Design Capacity
Total SSLW'
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding.Pohds. / Solid'Traps' ❑ No Liquld Waste Management System
h:f
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b- If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Squ,clure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier : ......... ...f'! .... ..............................
Freeboard (inches):
5/00
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
7:;w ri"
❑ Yes ❑ No
❑ Yes P(No
❑ Yes � No
❑ Yes P No
Structure 6
Continued on back

Fa ' ,tty Number:_ Date of Inspection printed on: 1/9f2001
5. Are there any immediate threats to the integrity of any of the structures obse d? ie/ trees, severe erosion, ❑yes [No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �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 kNo
o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence o�U­
licati❑ Exces
sive Po ding ❑ PAN ❑ HydrauIic Overload ❑ Yes o
12. Crop type ) i,34 � 1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit,by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
-yiolatigris :oi deficiencies were nbfed doting this'visit; - Yoit wril ieeeiye no fuit�gr
cor7es oridence: about this .visit
Commen� (refer to queshan #}:, ExpL�tn any-YIES answeirs and/or any reconixi"tions or''A atlier coffin
-.
Use drawings of fatality, to better explatn situations (i§Cadditional pag necessary) es as a
a tot a-f= vi �-
❑ Yes CNo
❑ Yes KNo
❑ Yes Zo
o
ClYes
❑ Yes ONO
❑ Yes [ &No
❑ Yes to
o
❑ Yes
❑ Yes 0 No
❑ Yes 14No
❑ Yes SfNo
❑ Yes CNo
❑ Yes Cf\No
❑ Yes ENo
❑ Yes dvo
viewerAnspector Name r 1;U"
�ewer/Inspector Signature: Date: t s/pp

n
Fact.lity Number: — Date of inspection Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 4No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes OJNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
roads, building structure, and/or public property) .
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes KNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �[No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes ®N\ o
lAddifional Comments-andforDrawings:
5/00

Division of Sorl and Water Conservation - Clperation Review {° �A
l ,t
w 0 Division of Soil and. Water Conseryaieon -Compliance Inspection
_ � � j vision of Water Qitrahty_, 'Campli �' p � �� ,� � �
ance ea�_� eet�on � -:a €�...:°:.e.a^� � ,� a""t .�� `i�a�t�s�.
a
:.13OElier Agency ,�peratton.Revrew'
_. _ ,.
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection D : j 24 hr. (hh:mm)
%Permitted © Certified © Conditionally Certified 13 Registered JE3 Not Operational I Date Last Operated
.............
..........................
FarmName: ................ C..................r-................................-....... County... L!....!.....................�..�L?.........
..........
Owner Name:... d�h ... S.r d Phone No. ............................'t1....6' a.
......... .....
Facility Contact: ...:CIO... . ........................ Title •............ ..t.S!~:�C..r........................ Phone No: 9�..:�.5,'d?�'3
MailingAddress: ............. .................................................... ................................................. .......................................... ...................... .................. I.......
N ec -t 1, l
Onsrte Re presentative; ....................................!'1�P�t��ntegrator:................ pl�.�'.liP'�.Q.......... 1!! t.. P • .................
Certified Operator :^�•rD �A t- Operator Certification Number:,,,,,,,,...
..... ... ...................
..... .............
Location of Farm:
Latitude a ' " Longitude 0 �� �66
Design `Current Design - Current - Design+ Cu`srent
-.Swine ,' -Ca acity'.'Pok Isition Poultry Ca acity. Population ,Cattle -;Capacr ".Population
❑ Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish I [1p I JE1 Non -Layer I I I I[] Non -Dairy
❑ Farrow to Wean
❑Farrow to Feeder ❑ Other
❑ Farrow to Finish 'Total Design Capactty'
❑ Gilts
❑Boars .:Total SS
Number of Lagoons . ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area'
Holding Ponds/ Solid Traps ❑ No Liquid Waste Management System
ti
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ElYes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ElNo
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'? (II' yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 . Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):.........`,..................................................................................
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
U�rNo
❑ Yes
t;(No
❑ Yes KNo
Structure b
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, C] Yes KNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: '01 Date of Inspection /
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 4No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes Qio
12, Crop
type
r 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes )QLNo
16. Is there a lack of adequate waste application equipment?
❑ Yes KINo
Required Records & Documents
I7. Fail to have Certificate of Coverage & General Permit readily available?
El Yes gNo
S. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes J<No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes 640
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes -,9'j No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes No
(ie/ problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes _5jrNo
24. Does facility require a follow-up visit by same agency?
❑ Yes 6(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 19:&o
0: �'Vo violatigns'or de'ciendes •were .h ee. dWi . g �his.visit: • Y:ou wiij r' eeeiye iW tuffte :::I
correspondence: about: this :visit: : i
Comments (refer -to question•#): =Explain any' -YES answers and/or any recommendations or any utlier comments:
Use'drawings of ftcthty'to better_explatti`sttuahons {use addtttonal pages asnecessary)
//tI � �/�i �s i'litrt'!�l /t✓lsi� _ %
� sx Awc.`> IC
_
C7DIa�S •� ir�I �lr 7A; S rJ1 rs~ �• 1,oa S C. �'lxyre,C9� `'�` �Sl t
.C,'r�S .1nw o l�.C�' Ar„n a /•/���. � �
Reviewer/Inspector Name ' 7'
ReviewernnSpector Signature: Date:

Facility Nurnber:3 Date of Inspection /
LOdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes `] No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KN 0
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'EfNo
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 1N0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes "�No
_ dlitiona •, omments and/or- ._Drawings:.
�5 k IV
J C �
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/s .
1�
Cy
WL0
Jq-SAt -6 s -(;V- CryC/IaT
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{ 'Division of Soil an�Water Conse'vation-°Operafion'Review
:Division of Soil and'; Water Conservation =Compliance Inspection
h Division of Water Qualyty : Cnmplance )Inspection
w -Other Agency ,Operation Review.
Routine 0 Complaint Q Follow-up of DWO inspection Q Follow-ur) of DSWC review O Other
Facility Number
Permitted 13�Cer..tiAfird © Conditionally Certified 0Registered
Farm Name: ....................................................................................
Yt�
Owner Name:...................................6&*
Facility Contact: .0�..'.I��...................
Mailing Address: .................................................
Onsite Representative: , �,,,,�T.,Rl.....
Certified Operator:
Location of Farm:
Date of Inspection
Time of Inspection 024 hr. (hh:mm)
10 Not O erational Date Last Operated .
County ti
........................................ Phone No:....
Title:.... k--- .......................
.......................................................•--................
Phone No: �..-..�w...
.................. ................................................. ................ I._ ..........................
........ Integrator:..... �.Q.S............... ...............
Operator Certification Number:
0' 0` 0'`Longitude
Latitude
Design Current Design Current _ : Design' Current:-=4
Swine .' _.... _ .. ,.,
Capacity Population Poultry 'Capacity Population Cattle Ca acity Population <
❑ Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish ❑ Non -Layer ❑Non -Dairy =
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts.
❑Boars - Total SSLW
Number of Lagoons _ ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holcirng Ponds /Solid Traps ❑ No,Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any Part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I
Identifier:
Freeboard (inches): ..........'M....
Structure 2 Structure 3
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes ,[No
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
.... ...............................
❑ Yes gNo
Continued on buck

ppp-
s
s

FNcility Number: `3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes KNo
(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
gNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
tdNo
elevation markings?
Waste
Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
kNo
11.
Is there evident of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
XNo
12.
Crop type t `y /st-,
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
kfNo
b) Does the facility need a wettable acre determination?
OYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15_
Does the receiving crop need improvement?
Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
DdNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[(No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�(No
24. Does facility require a follow-up visit by same agency?
❑ Yes
CKNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O(No
yiol'atidris or deficiencies •mere potted• diitirig •this;visit. - You ' ill •reoeiye ti6 further: '
torrespon nee ah4ut this visit_ . . . . .
Comme is (refor to.question #):Expllai6 "i YES answers and/or.: any recommendations or any-bAe—r comunenti-
Use;drawings of facility to: better explain sttuations (use additional pages as necessary}
A.
Ya CAS ilk
Fly
�c�►�
.Oe
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ Date:
3/23/99

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-acility Number:3 Date of Inspection
Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
(]Yes
"No
liquid level of lagoon or storage pond with no agitation?
2T
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
K'NNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
( No
31.
. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
XNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ONO
3/23/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
M Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection I W_0LJ24hr.(hh:mm}
0 Registered P Certified [] Applied for Permit 0 Permitted 10 Not O erational Date Last Operated:
Farm Name: 6 o . I . . . .... County• I l�!.N......................
Owner Name:.... �.�.....° s14 ................................1............................. Phone No:....f r11Q�..... Zq�a :..�Z Z.............. .........................
Facility Contact: ...................................................................... ... Title:....................... ... Phone No:
MailingAddress:............ � �.. z)Q...:....14.4..............................................................•-- � � �v.J.L'.. NC.................................... Zn.q .........
I....
Onsite Representative:...........�VIk. .5�A ........................................................... Integrator........ tn4.......................
Certified Operator:..................NLLSOV� ............. . Operator Certification Number:-.1.20,,,, ........... ..,........
Location of Farm:
....50 . e SL.nw.".11.2......fti 5....wis........ l..I!.:..............................................................:.........................
.--........-- ........................................-----...------....------....---... ..
Latitude 0• ®4 Lf
❑ Wean to Feeder
Feeder to Finish
Z} & Ci
()
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number ohLagoons'/ Holdwg Ponds. Subsurface Drains Present Lagoon Area Spray Field Area
F {] No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes [� No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? Cl Yes [A No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes q No
c. If discharge is observed, what is the estimated flow in gaUmin? tj
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ) ❑ Yes ]$a No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes EA No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 14 No
7125/97

Faeili 'Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsJlolding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft):............. 1.t7............. ....... I ............
................ ...
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 maintenancelimprovement?
(If any of Questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
Structure 5
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................................... 1'Al...... .!;yz k ...........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewerlinspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violatio'ns-oi deftiencies.weredoted-during this:visit.- You:Aiill i-ecei've-n' o further-
' 0&t pOdehce dhoid -this.visit;
5,�,5 atounyl taw b:n� S�uiU
sw\-kl�
Lj� , � At)s. Situ J
ky. Scoff h0.s
2�- t ooti des7c�(� SkOA 6e- LK Ary, ,rtcords. OU P
[aM Ow t�S� tt�c�o} f&low. tC�ca �
" A— SaNgYaty� �� i� rcinAS � W�1 n
❑ Yes
E] No
❑ Yes
No
Structure 6
❑ Yes
[P No
❑ Yes
[ No
❑ Yes
No
❑ Yes
No
❑ Yes
10 No
❑ Yes VNo
❑ Yes ® No
Yes ❑ No
❑ Yes 0 No
❑ Yes JA No
❑ Yes B No
'R Yes ❑ No
❑ Yes A No
❑ Yes `P No
❑ Yes 51 No
�Ir
{{ �L �' jO�tccS��ly� k�
t Is cvfV4 � mvi S c . Corm
wu A. Co{�� "k
Val.,,, us kUla
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: t

O Routine Qf Complaint O Follow-u of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection--'>`=�
F_ Facility ;dumber
Time of Inspection I ; i / 5 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: 10 Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel and rocessin
❑ Not Operational Date Last Operated: ...... ...... _.......... _........ -- ....__....._ ....__.... .._. ...,,..... _......
FarmName:. ... � .....nth ............ ............ _....... _ .... _.. _ .... County :. _.. �i1... .... _ ... _w..., _ ...... ...._ .
Land Owner Name:..._...i ..P.l Spa. Phone No:1 .V.;_ 2 4 �::1-7 ag---- ...__.. ..._.....
Facility Conctact:......,Am.... S__._......................... ........ Title: . Phone No: _.......
Mailing Address: ......_................ _.... _ ...._._....... ..... kAkA#A.S.)iALrA)C---- ----- ......
Onsite Representative: �.s�[cun.Q{ Integrator: ....._...._........_................�......................... Int ator: _...--- 1(bls?�t..1...................r......__...L..........
..............
Certified Operator: ... AGAW.e.� • �.114 7%t ,:.„ ......_........ Operator Certification Number: { lV
Location of Farm:
�. ll.......! ,...�.c.a�,p... Le._ ...aa...._
...._..... ..._............... -........... -.. __...._- . _...._ .... - ....._ ._. -..... _ ....__.... __....._ ......... �y
Latitude �•` �" Longitude•
Type of Operation and Design Capacity
R x
Design Current Design CCure ent Uesg° t
Smite w�Ca aci �Po �[ation� i?oultry Ca aci Pii elation : Cattle V . �,:Ca ace : <Po elation
❑ Wean to Feeder ❑ Layer ❑ Da'
Feeder to Finish U ❑ Non La er ❑ Non -Dairy
,'
Farrow to Weanr t4�4p
Farrow to Feeder Total Deslgnt Gapaeliy� O
Farrow to Finish
Other �
WTI T66 € SSLW� 2R
x �
Subsurface Drains Present
a
_ ❑Lagoon Area ❑Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach 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?
Cj Yes ❑ No
❑ Yes Q No
❑ Yes §@ No
❑ Yes Ep No
N
❑ Yes 0 No
❑ Yes 0 No
❑ Yes V4 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes [A No
Continued on back

Facility Number:......—.3°1. _
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IN No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (1,39,00ns-and/or Holding P n s)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
C'Yes
❑ No
Freeboard (ft): Structure I Structure 2 Stricture 3 Structure 4 Structure 5
Structure 6
�$ .......... _ ..... ....... ...... ..........» .... ......... .»...... »» . »»....».»..... ....
...............
» »
10. Is seepage observed from any of the structures?
❑ Yes
RNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
19 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 Ievel markers?
❑ Yes
No
A'aste Application
14. Is there physical evidence of over application?
❑ Yes
ELNo
(If in excess of WMP, off rpnoffentering waters of the State, notify DWQ)
C�
15. Crop type ... ifs ... ._........ .. _ .... ............. » ... _ ... _................. »
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
I7. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement? [.Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes JdNo
20. Does facility require a follow-up visit by same agency? MYes ❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes NNo
For Certified acil' i
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ®No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes IgNo
24. Does record keeping need improvement? O Yes ❑ No
Comments (refer to question # Explain any YES answer andlor any recommendations or any other comments
Use diawings of facility tabetter ezplam situations (use additional pages s necessary
. l a b
�Z. &w a4t4-p, �ttoUit1 mSee4ka. Gvo�;&, cud �y ��Y�� ��, IAWle"
ww w; k Gia� a sue dtd.
4g. &.V"46— WO,', 7/to/q-7
y#, s� recopy .�j,,,��ci �� ��� by riser �s . Use �+n'►�gtian firms P►�r�?
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No-2
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 711 C 1995
Time: i - 3a
Farm Name/Owner: 1Lw
Mailing Address: eo -1 & v
County: , s w
Integrator. w --s �l �4f-�1:�4 _ Phone:
On Site Representative:- C c y It- _ Phon�2���Xg 4 la __LC_ �
Physical Address/Location:. 1 3uy /1 ��•�3� !�2 vk, l� _ y7 07 7
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: °"7 a,u x 3 As,, -ix Number of Animals on Site: .D o00
- 00; � 6
v.
DEM Certification Number: AC DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot +• 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes o�y Actual Freeboard: __0 -Ft. -,V-- Inches
. Was any seepage observed from the lagoon(s)? Yes or69 Was any erosion observed? Oor6S/�J�f •
Is,adequate land available for spray? Yes or No Is the cover crop adequate? Yes or&
cfq-�s
Crop(s) being utilized: jj,:L�_ L,,Wt ,,4ti1 r-A _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e or No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es 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 or(�% If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land app 'ed',
spray irrigated on specific acreage with col cro )? Yes or n, 1 S
Additional Comments:`
r
Inspector Name
cc: Facility Assessment Unit
Si tune,
Use Attachments if Needed.

•
Site Requires Immediate Attention: t/
Facility No;./ -
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3— , 1995
Time: 3.5 4-
FarmName/Owner:
Mailing Address:
County: U , 1/1
Integrator. 6 rUkA' A S Phone:
On Site Representative: `f Phone:
Physical Address/Location: �D �' an cam y
l.e
H-Ard b sdirT1 e [ -roUri-•
Type of Operation: Swine Poultry Cattle
x
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° 1 Longitude: 7? ° 5Z 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 o No Actual Freeboard: _Ft. Q0 Inches
Was any seepage observed from the Iagoon(s)? Yes of Nc Was any erosion observed? Yes or�N
Is adequate land available for spray? Yes or N00 Is the cover crop adequate? Yes or No ?
Crop(s) being utilized: Z
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste Iand applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No Z
Additional Comments: --ha- one- on
is Inspector Name Signa e
cc: Facility Assessment Unit
Use Attachments if Needed.

•
•
[PERAT TUNS HRWVCH - WQ Fax : 919-- e 15-bo48 Jul 18 ' 95 12 :08 P. 09/23
Facility Number: 3._L.6
SITE VISITATION RECORD
DATE: 1995
Owner: 10 kn �SC.d Farm Name:
County: _P aC, _ T, 4
Agent Visiting ,site: Phone:., -06 — �v 24
Operator: _ - - _ Phone -
On Site Represent
Physical Address:
Mailing Address:
Type of Operation: Swine -A— Poultry — Cattle
Design Capacity: � G Number of Animals on Site_
Latitud4--. • ° Longitude: —cl `
Type of Inspection: Ground 'T: Aerial
Circle Yes or No
Does the Animal.Waste Lagoon have sufficient freeboard of I Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or To Actual Freeboard: Peet tl�!_ Inches
For facilities with more than one lagoon, please address the over lagoons' freeboard under the
comments section.
Was any seepage observed from the lagvon(s)? Yes o Was there erosion of the dam?: Yes or Na
Is adequate land available for land application? Yes or No is the cover crop adequate? Yes or No
Additional Comments;
Sn[:e cF A=Fax to (919) 715- si59 Si1

J Site Requires Immediate Attention: v
Facility No. U IZ2
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION. RECORD
• DATE. , 1995
Time: 3/y
Farm Name/Owner: CQ
Mailing Address: Kal",;L ---
County: �L1,,i6 ti
Integrator: 160 C Phone:
On Site Representative: 7dGN w Phone:
Physical Address/Location: N C- S K t o u :: -g jz/i-,S < f'� )1q4-
Type of Operation: Swine Poultry Cattle
Design Capacity: a I Number of Animals on Site:
DEM Certification Number: ACE . DEM Certification Number: ACNEW
Latitude: 2 ° ��' _" Longitude: :77° 15� DL Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: —3—Ft_ -0 Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or00.
Is adequate land available for spray? Y or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes 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 orp If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
J+M
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

0
Site Requires Immediate Attention* _
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEIIENT -3I—
ANU AL FEEDLOT OPERATIONS SITE VISITATION RECORD 3l�
DATE: - , 1995 3 j b
Time: 1 Z0
Farm Name/Owner: 5roff Form
Mailing Address:
County:
Integrator.
On Site Representative:
Physical Address/I
Type of Operation:
Design Capacity:
S wine ✓
Phone:
Phone:
Poultry Cattle
Number of Animals on S ire:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot ; 25 year 24 hour storm event
(approximately I Foot + 7 inches) es r No Actual Freeboard. !_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oeWas any erosion observed? Yes r No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from R`ells? Yes 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 ma_n=made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain -
Does the facility maintain adequate waste mana;ement records (volurnes of manure. land applied.
spray irrigated on specific acreage with cover crop ? Yes or No 1 1
Additional Comments: � 1 -- rl.roS V Q0Q T 8— 6�
G `3 v r- -
G -L d
4e r11.
G G-
Y SC-1 3'-(," -sC 2 3 0 5C4 V-U"
Inspector Name
cc: Facility Assessment Unit
24
PC_.
signature --
'Use :attachments if Needed.

•
37 3
Site Requires Immediate Attention:
' Facility No
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: :2 — ,_, 1995
Time:
�J �.
Farm Name/Owner:T ]�v H I �� J� � cl� ��
Mailing Address: ltllr,, f VL
County:� n 1 ) sa-
Integrator: 1 Phone:
On Site Representative: tJ -ni 6 ra Ole, Phone:
Physical Address/Location: Cla3i S t
hAA
Type of Operation: Swine / Poultry Cattle �� ��+►1f
Design Capacity: IS'6D Number of Animals on Site: _JZ-0-0
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 9L_" Longitude: S'_"' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Ye or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)?' Yes or No Was any erosion observed? Yes or No
or No Is the cover crop adequate? gor No
Is adequate Iand available for spray?
Crops) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?QV or No
100 Feet from Wells? ce, or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or09
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 019
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover p)? or No
Additional Comments: �9, "Q,-d -�- cpc� o wt
inspector Name -�
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

�l-fib
Site Requires Immediate Attention:
' Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: — , 1995
Time:
Farm Name/Owner:
Mailing Address:
County:
Integrator:
On Site Representative: -jt�-e
Physical Address/Location:
Phone:
Phone:
Type of Operation: Swine �(� Poultry Cattle Tt c jLlc� vt,
S
Design Capacity: `�L:7 52) Number of Animals on Site:
DEM Certification Number: ACE' DEM Certification Number: ACNEW
Latitude:_° Longitude:7&- a '�5- 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) or No Actual Freeboard: �Ft_ Inches
Was any seepage observed from the lagoon(s)? Yes 00 Was any erosion observed? Yes o�
Is adequate land available for spray? es or No Is the cover crop adequate? .�s br No
a Crop(s) being utilized: sS�� ((- ( 4„ f, � �i G-) !n 1.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? I e or No
100 Feet from Wells? des or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spec' is acreage with cover crop)? Yes or No j
Additional Comments: c7 Q F c
Cd 4 C( 4, a
!.�
Inspector Name Signature
a"-j
cc: Facility Assessment Unit
Use Attachments if Needed.

•
0
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 -2-2 , 1995
Time:
Farm Name/Owner-
Mailing Address:
r
County: vi
Integrator: _i T \ L.
On Site Representative: 4
Physical Address/Location:
Phone:
Phone:
Type of Operation: Swine PoultryCattle
Design Capacity: �:2 :7 5 d _ _ Number of Animals on Site: a 7 S7c
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: '_° �` ��" Longitude: 7ss 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)(9or No Actual Freeboard: —/—Ft. 7 Inches
Was any seepage observed. from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available or spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: m t q Id,
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (Gor No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oi(!
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 0,0
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes OP
If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on
Litional Comment:
Wk,�(�
i d--
nspector Name
acreage with cover crop)? QYeqor No
Signature
/_'_-j 4
cc. Facility Assessment Unit
11
Use Attachments if Needed.

3l-3`7_0
A
Site Requires Immediate Attention:
Facility No.# -
-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:_ .�Ct
Mailing Address:
County
Integrator -
On Site Representative:
Physical Addresaocation:
DATE �7.Z -, 1995
Time_ :
pju
Phone:
Phone:
r-
-� U
Type of Operation: S wine Poultry Cattle v1
S
Design Capacity: Number of Animals on Site: 'G1 s- 9
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° _.jjL_' tUC-" Longitude: Q 7 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) ,Yes or No Actual Freeboard: -.2—Ft._ Inches
. Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray?oor No Is the cover crop adequate? Desor No
Crop(s) being utilized: k o r o Obi • S VYlg I 1 Q 44 1 o n COQ6! E
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? '6or No
100 Feet from Wells? )(@!�br No
Is the animal waste stockpiled within I00 Feet of USGS Blue Line Stream? Yes 06 .
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar roan -made devices? Yes o i o If Yes, Please Explain.
Does the facility. maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acrea e. with cover crop)?(9 or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.