310391_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: Q Co liance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: C Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 12= Departure Time: 1= J County:Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �n-e
Certified Operator:
Title:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
'Layer
Wean to Feeder
Non-L;
Feeder to Finish a
Farrow to Wean
Farrow to Feeder
P!Nn-PL,
Farrow to Finish
Layers
Gilts
Boars
Other I I IMI (Other
Latitude:
Poults
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:
Cy ow
Cy alf
Hy eifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ o
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412015 Continued

Facility Number: jDate of inspection:
Waste Collection & Treatment
4. Is.storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P'No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 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 ❑ 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 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes YNo
o❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes C2/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 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 [)
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes N
❑ 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 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes 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 oil 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 Wo ❑ 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

Facili Number: 11- Date of Inspection: —7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C ❑ NA ❑ NE
25. I's the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZN ❑ 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 ❑ 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 0 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 ❑ 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 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 Cj o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments "(refer to question ft Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages, as necessary).
Reviewer/Inspector Name: Phon�:
Reviewer/Inspector Signature: Date:
Page 3 of 3 214415 S

Type df Visit: (9) gRoutine
mpliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
isit:
Reason for V0 Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:® County: f,�GcL Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title-. Phone:
Onsite Representative: VC, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
19g7S
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultr3"
FTLayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oul
Layers
Design
Ca _a_ci
to ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes E�/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [—]Yes ❑ ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes O 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 21412014 Continued

Facility Number: ?,1 - 1 I
I Date of Inspection: y ► („
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A &6-dd
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �26 _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? 7/Yes [:]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes O/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 CNo
❑ 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?
1 I. 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 WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes oNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes o
VN
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FaciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check FYes ❑ No 0 NA ❑ NE
the4appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
ENon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: /a/LO&
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ONo ❑ NA ❑ NE
❑ Yes [ N
❑ Yes it No
7:/
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes D'N�O
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E2 1"o
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Comments. (refer to question #) Explain any YES, answers, and/or.any_,additional recommendations" "or any" other-comments� "
IIse drawings of facility to 777--]
better explain situations `(use additional pales -as necessary)'..
`� > O4 kk �.I � u• AIC (-,DS SI N^ E G SS �✓¢!2K .
a ► -P
ReviewerlInspector Name:
ReviewerlInspector Signatm
Page 3 of 3
WHcd PA
Phone.No x 13 gg
Date:
21412 115

Type of Visit: Q 70utine
lance Inspection V Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint Q Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 5 /5 Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �j t< e 5/'"� �� Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry C*apacity Pap.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er I
Dai Calf
Feeder to Finish 7
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I] , I;oult . C•_a aci P.o ,
Layers
D Cow
Non-Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharess and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes (—]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [—]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
❑ N
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 3
21412014 Continued

Facility Number: ei i - 311 jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): Z�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes To ❑ 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 dNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O NNo ❑ NA ONE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑'Nv
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[dN�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�rNo
❑ NA
❑ NE
Required Records & Documents r�No
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 ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2l. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 16 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 [DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 3 -3 q Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EB:46
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ICJ o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
�° ❑ 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
❑ 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
E?rNo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[!`No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
u N ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or:anyadditional 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
0-7l lUo---e%
Phone: 7 {0 ?(V
Date: 'Q/1.5
21412015

Type of Visit: 0 Co pliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 5 Arrival Time: Departure Time: p County: DUP Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: gi Ede SrA:S:rA Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pap.
Feeder
Non -La er
DairyCalf
o Finish
o Wean
to Feeder
2 Q
Design C*urrent
Dr P,ouIt. Ca aciP,o
DairyHeifer
D Cow
Non-Dato
Finish
E
La ers
Beef Stocker
Non -La ers
Beef Feeder
PulletsBeef
Brood Cow
Turke Poults Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
(No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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?
El Yes
Vo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 5 -7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 11 Structure 2
LA
Structure 3 Structure 4
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?
Structure 5
2f'No ❑ NA ❑ NE
❑No ❑NA ONE
Structure 6
[—]Yes No ❑ NA ❑ NE
❑ Yes [dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm7e/Pio
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 7�/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
[Z No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
flN�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
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
❑ 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 I" Rainfall Inspections/ ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yesg"No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IFac!Hty Number: 151- Date of inspection: S 7
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 g No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. 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 fait 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
CZ/No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
dXo
❑ NA
❑ NE
[:]Yes
WNo
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
10
rA
F ;
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments..
Use drawines.of facility to better exalain situations (use additional Vaacs as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
.J G
Phone:
Date: 5 "]
214120 1

I Type of Visit: " Q rRoutine
Hance Inspection U Operation Review U Structure Evaluation UTechnical AssistanceReason for Visit: O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: t Arrival Time: R �S �� Departure Time: County: ,O&xf(aPJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: STEyC S =Cul
Certified Operator:
Phone:
Integrator:
Certification Number: 199 7 8
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
I INon-Layer I
Feeder to Finish
2
(.00
Dairy Heifer
Farrow to Wean
Dr, P,ouIt ,
Layers
Design
Ca aci
P,o ,
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Da'
Beef Stocker
Gilts
I
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ONE
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 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 ❑ o
[:]Yes
❑ Yes rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ 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: lr.}
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on which are not properly addressed and/or managed through a
[—]Yes
dNo
❑ 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 environment i threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [I�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EdNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EdNo ❑ 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
ro
❑ 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[51t4o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [-]Yes go
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: I 13ijil
24 ;Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes�Zo ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes C No ❑ NA ❑ NE
❑ Yes O/No ❑ NA ❑ NE
❑ Yes ffN/o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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
dNo ❑ NA ❑ NE
�Fo ❑ NA ❑ NE
[/No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES, answers and/or any additional recommendations or:any_Other comments.:,:
Use drawin s offacili to;betterex lainsituations useadditional a esas necessa
h t3 p { P h ry)=
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C;'11 AS
Phone: oarg.L— D D
Date:
4/1 J 11

type of Visit: 0 ZRoutine
pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Zeason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: d U = Departure Time:® County: IJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �y� c]iy _TA Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
swine Capacity Pop.
Wet PouItnY
Capacity
Pop.
Cattle :opacity Pop.
Wean to Finish
La er
Dai Cow
Non -La er
Dai Calf
Wean to Feeder
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D , P,oult ,
Ca aci_
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
n 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 the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
O
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. I6 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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
WNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 21/; 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 U /No
❑ 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
❑ ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
VNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
rZ N ❑ 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
N ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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? [COD)Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: IL
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
Ezr
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
��N(o [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3/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
U2flNo ❑ 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
CJ/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
E No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [%� o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [% No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

1�>
Division of Water Quality
acility Numlier` I 0 *jsion of Soil and Water Conservation q�� :�
Ageney.
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit l0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 1 i Arrival Time: t56 Departure Time: �� County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: • , Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o r1 , Longitude: = ° = t = `A
F Design Current Design-,-, CurrentM Design ,'Curr nC
rt
Swine Capacity Population ', 'Wet Poultry Capacity Population.; Cattle Capacity .Pop at n
El Wean to Finish ❑Laver ❑ Dairy Cow
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
°ILI Non -Layer I I
.I)ry,Poultry M
- x
,AU Boars I
Ot�e�e
'" ❑ Other`
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharims & Stream ImRacts
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 Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
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 e No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: 3 — Date of Inspection L l [
*.
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: (At!'ry6tJ
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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes El No ❑ NA ❑ NE
❑ Yes ZI/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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LEI 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 L' I No ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ N ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�0/No
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
7,No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is lack
❑ Yes
�rNp
El NA
❑ NE
there a of properly operating waste application equipment?
Cl Yes
❑ NA
❑ NE
Comments (refer to;gpestiom#) Explain any YES;answers�andlor any recommentlattons or any-other'comments.�':°k
.�w� ,,
Use drawings of facility. to better explain situations (use'additibnal pages as necessary)
Edpy�
T
Reviewer/Inspector ector Name
P C� (/<� � _ Phone o �? Z
Reviewer/Inspector Signature: Date: t S 111
Page 2 of 3 12128104 - ` Continued

Fig cility Number: 3 Date of Inspection L T
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. ❑ ATUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes L'I No ❑ NA ❑ NE
❑ Yes i1J No ❑ 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 V
Rain Inspections O Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
LJJ No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
dWy�lo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L2 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E� No
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U? 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
Ll 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
,�,/
L1 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
rNo
❑ NA
❑ NE
AdditionakComments and/or Drawings: ,
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitRoutine 0 Complaint 0 Follow tip 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f Arrival Time: Departure Time: County:Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: (r' Title:
Onsite Representative: ;-rtaed , mm-T bi
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = i = Longitude: = o = ' 0 «
�ill�lii NON!
III Design Current
IN
Design Current
DesignF04'r-jte­fftM
I
F
Capacity �P�opLLulatiop
W,et Poultry. Capacity Population
Cattle apacipulation
n to Finish
rW
❑ La er
❑Dai Cow
an to Feeder
❑Non -La er
❑Dai Calf
10 Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
❑Beef Feeder
l
Boars
❑ Pullets
❑ Beef Brood Co I
❑ Turkeys
Other
❑ Turkey PoueIn ts
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Yes
El]
id No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
;40
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

{C
l �
t
Facility Number: 3— q Date of Inspection Z 0
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: r-A(067,)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zb
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
El Yes
— No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
L( No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
1
LEI 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 ZNo ❑ NA ❑ NE
❑ Excessive Pending ❑ 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
00No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
"
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
�7No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
y
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ld No
❑ NA
❑ NE
-. _..�
._
..,�;��
Comments {refer to question#): ExplaEn:any YES"answers and/or any:recomrrtendat�ons orpany other comments.
Use drawings of facility to better explain situations (use additional pages as ne :asa y') x
IReviewer/Inspector Name .F1 Phone: Up 176 ' /3VF
Reviewer/Inspector Signature: Date: 1S /)
12128104 Continued

t
1,11,
Facility Number: 3 3q Date of Inspection S D
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.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes o ❑ NA ❑ NE
❑ Yes ;rNo ❑ 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 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
Q4
El NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
1, .
[I NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
L'J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LINo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
El,
ld 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
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
PNNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ld
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
U No
❑ NA
❑ NE
12128104

Type of Visit Qr7Rioutine
pliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: s� Arrival Time: Departure Time: County: 1911Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: SrC-Vt Ym,.tru Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = I = Longitude: [� o = i
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C►apacity Population
Catkle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish Q $%
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultty
❑ D Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
ElGilts
❑ Non -Layers
❑ Pullets
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 QNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

acility Number: 31 — 3 Date of Inspection S I 9
i;Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ENo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 1A HIV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ;'V
5. Are there any immediate threats to the integrity of any of the structures observed?
ElE 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
dNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[/� Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenancehmprovement?
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 ld lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
7) �Nt�,vuE 90cE LIAL . kIV Kk —
Reviewerlinspector Name iJ Al ,MtW( t 00 Phone:( WO /YG 7751 AF
Reviewer/inspector Signature: Date:
Page 2 of 3 12128104 Continued

I
Facility Number: 31 — Date of Inspection 3'
It
r�Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily availabte? if yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[21No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Elld Yes
,.dNo
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ 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
[ /No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
dNo
❑ NA
❑ NE
f yes, contact a regional Air Quality representative immediately
1
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Ef 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
jNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

[Facility Number 9
U Division of Water Quality J
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit fU Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: S t? p Arrival Time: c}Ob Departure Time: County: 7tiOl_7-0 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: TCo S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 ❑ g Longitude: ❑ o [__1 ' ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer l i�
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
at6o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current"
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 CI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
o
El Yes
WNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

I
Facility -Number: 3 ` — q 1
Date of Inspection 1 �► o
Waste Collection & Treatment ,(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes /LI 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: LA Gcm&l -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): as
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ElYes F4o. ❑ 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? EKes ❑ No ❑ 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 [,io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No ❑ NA ❑ NE
maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes EK ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑'No
❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,YNNo
L dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
��No
❑ 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,} Cy�rr►Jt3 E �2jC� Wo12 t_� ADD FCrZT rltEr4 A
Reviewer/Inspector Name L)o N - n1 o,4 644,tqGS Phone: Q10
Reviewer/Inspector Signature: Q.,Y,2�, Date: I(,g
12/2R/Od Continued

1 -
j
Facility Number: 3 - 3q Date of Inspection 1 t�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes � NNo El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes E2 No ❑ NA ❑ NE
the appropirate box. ❑ V*1UP ❑ Checklists ❑ Design [I Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
[IYes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[jlo
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El[ Yes
N"o
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,
LINo
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
0<0
YNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
6d 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
�
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
7No
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
LJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number
(Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
8. yf Departure Time: County: AAZL g
Date of Visit: l+ O� Arrival Time: _..,., Region:
Farm Name:
Owner blame:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: .01FAa n1-L �q Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 4 = Longitude: = o = 6 = {1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�. ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp_es & 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?
Cattle
Design Current
Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Dumber 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 U,114o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
[I No
❑NA
El NE
El NA
❑NE
El Yes
❑N
❑ Yes
No
❑ NA
El NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

,yacility Number: Date of Inspection y ,
.s
` Waste Collection & Treatment /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ 2 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: M (�N
Spillway?:
Designed Freeboard (in): 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2fNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes LEI 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 envi7yes
ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ No ❑ NA ❑ N
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes eNo ❑ NA ❑ N
(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 LJ No ❑ NA ❑ NE
NE
NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D No El NA ❑
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes [! No ❑ NA ❑
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl El Application Outside of Area
E
E
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L7 No ❑ NA ❑ NE
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
❑NA ❑NE
❑NA ❑NE
❑NA El NE
❑NA [I NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
[A&oN dEs1(4 idl" sJ-w 1,1TTWDj 300A 1. 166b 6►iY Td WX0 OwQ
`
7 J /VEERf' 1_01Ji)X. IW o I-1- YAI DAM 1v41_(.. 1,VXITE /✓dTt` L,ItI4 CO".(
1,114) % T "I Vc)/v'-� NVV RA r(o .
Reviewer/Inspector Name Phone: g/o — 3
Reviewer/Inspector Signature: >6d&Date: r o 7
/ 12128104 Continued

Facility Number: —311 Date of Inspection t( a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check dyes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists Q Design ❑ Maps ❑ Other �
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Egv"o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El"No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�O
E2" o
❑ 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
R% NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
ElNE
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
LI 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
ENo
❑ 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
NNo
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
�
Ej o
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number 3 3
Division of Water Quality /
O Division of Soil and Water Conservation v/
-
Q Other Agency
Type of Visit Co liance 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: (p 6(/ Arrival Time: L� '�
Departure Time: County: DV Region:
Farm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: atw re �S WyXTU
Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm:
Latitude: 0 c = 6 = is Longitude: = ° 0 d = it
Design Current Desigq Current Design. Current:«
Swine Capacity Population Wet Poultry Capacity. Population Cattle Capacity Population ).�.t
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
U
I0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Oth_ er.
❑ Other
❑ Layer
❑ Non -Layer
Dry. Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowi
Number of Structures v�C
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
1.
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2/No
❑ NA
❑ NE
❑ Yes 2 1Vo ❑ NA ❑ NE
12128104 Confinued

Facility Number: 3 — Date of Inspection ` o
`Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structur 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C—I 66
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �Y
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
O/No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [/Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[2/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
G(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes
ZNo❑ NA ❑ NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
Ej No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) QE(t�W►t/OA L k) S 6 o C.{oo_5
. 1,
13. Soil type(s) :PA GTd j c�a aA).f A4 A�YN
,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(T'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
:t
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
VYO
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
L7 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments...
Use drawings of facility to better explain situations.. (use additional pages as necessary): ,
L A G o-a J Lk."ek-6 WALL. XN �L+� C S � E E3 �wP 2d�1 iT- .�N 6":; 3 C4Vf .
Wdr L� Zr,1JC, W=Tf4 94-- t;J 61J LAGdaAf 6EST-&AI,
Reviewer/Inspector Name1,i� ���� 1 Phone:
Reviewer/Inspector Signature: Date: 60p

Facltity Number: ] — L Date of Inspection to b
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 C7De�ign
readily available? If yes, check
El appropriate box. WUP ❑Checklists ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes ET//o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L"No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No Ld NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,❑_ No
�TA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes LI'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No El NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes 6 No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes DNo ❑ NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes 31 o ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes Q4o ElNA [INE
Elm Yes o ❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit r0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a '
/ D Arrival Time: eparture Time: County: U GZ/✓ Region:
Farm Name: ��FiJf ��3't�76� f'fie/�'L Owner Email:
Owner Name: / ��ie�7/�/�/ ��j i'Y1Z?� Phone:
Mailing Address:
Physical Address:
Facility Contact: l �/nZTfi� Title:
Onsite Representative: �!nZTw___
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = N Longitude: = o 1--1 ' = "
Design Current
Design CurreriY
Design Current
GO- eityPop iotr
VT r ry�rCapacttj.Pop lton
Cattle_ .. Capacity Population
❑ Wean to Finish
❑ La er I
Iry
Cow
❑ Wean to Feeder
❑ Non -La ei
❑Dairy Calf
Feeder to Finish
621911❑
Dairy Heifei
❑ Farrow to Wean
Dray Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
[] Beef Stocker
❑ Gilts
❑ Non -Layers ers
❑Beef Feeder
❑ Boars
Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Pouets
❑ Other
❑ Other
I
Number of Structures:
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes 0No ❑ 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
e. 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
Vj No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
F-1 Yes
P No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Wl
Spillway?: P
Designed Freeboard (in):
Observed Freeboard (in): -24
5. Are there any immediate to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmentaaltheat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
O Yes A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
to
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.
. ,(
El Yes IJ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift p 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
A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
8 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
�R11Z ,4T L-�N76L4L�. ��Lf �Q /T� v 42!:- Ar—PS.S &,t�1]AI
n I
GJ,�7ClL S 14 ? z5(R, �C.lgiJ ; A4o-') &45-7� '70-
���G�I,Df�O Y'�,e✓zv �o �
Reviewer/Inspector Name'f f �zr's°a! 4, Phone: %�5� ��
Reviewer/Inspector Signature: Date:-1/w/Rig
IZ,28/04 Continued

Facility Number: 3__yF1 I Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes JVNo ❑ NA El NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
4 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VrNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
( No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge`?
❑ Yes
7fNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
gNA
❑ 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
ElNA
ElNE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
12n
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
fi�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LNo
❑ NA
❑ NE
Additional Comments anti/or Drawings:
/ i4'l� �c-opr% 7��s ri Zervzc,c_ � �- 5 -1N`5��7�osJ,
'S CR ass
/. 5A?, Ap'A,,' Harz &Iuv . Nsr�� �� /�5aAg-
��`
I
12128104

Type of Visit it0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit SD CoRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of visit: 3 G Tune:
Facility Number 9l
O Not Operational O Below Threshold
© Permitted 0 Certified © Conditional Certified 13 Registered Date Last Operated or
bbo� Threshold:
FarmName: ... ll. » t ..._..�..C?».....................:».....................».» County: »..... i't��G�f'..................»................»._.......... ».
Owner Name:
Mailing Address:
Phone No: .....»._. ...._,» ..... ....... »....»» » .».
FacilityContact: .._ ...............................»»....» ..........................-- Title:..»..............»..................»..»....»..........». Phone No: ».».»....................................
Onsite Representative 'LCdL.6.... L!1 ....» » »...._._.. ..».».. _.» .... Integrator.
Certified Operator: ................................................... ... ................. .................... ..... ............ Operator Certification Number: ............................. ....
_
Location of Farm:
w
[]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' r�" Longitude �• �� ���
Design ;Current - Destg>€i Cnt , _Design <Current
Wean to Feeder
Feeder to Finish
Elt 0 `
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
Discharges & Stream Impacts
' J0 Non -Layer
° ❑ Other
al Death
N
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JAO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes/No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: . . ...».»»_......... ».».... »_.»..».......».»... » » ._ ............»�.» ».... - »......._�......
Freeboard (inches): �5
12112103 Continued

Facility Number: 3 —
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 A hcation
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑-PANTr' ❑ \Hydraulic
Overload
s� ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 117u 1 L / 71�141L rvgAv � n %hif:,QT, !
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWW)?
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?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes )dNo
❑ Yes)2(No
❑ Yes ZNo
❑ ye(NN`o
❑ Yes Xo
❑ Yes /$"No
❑ Yes4`0
❑ Yes fa No
❑ Yes 0
❑ Yes /B'�io
❑ Yes�No
❑ Yes No
❑ Yes �No
❑ Yes �No
❑ Yes No
❑ YesXO
❑ Yes�o
Comm s (refer to ques. E p veers and/ar aay r e�a�meadatzons or any at rr comments. �
�y'irES�
_Use drawmgsof�facs'hty to�bett�er e�'stt dons. (nse.addr#�a alpages as necessarY)� F eld CvPY [] Final Now tes�.
.� �.°�
Ofpc�ssrd S AT P ,sEn_ Co�u �le� R� fww►�,e.� �IeEo T �� SP K�-
a
S STEM TQ Pvr dnl FTr"Sb �JE6b 1WA DE��FSS.? 5h�5 AR IUs�'
A W AtVWANc,EJ kC-P-f
FCc, RDS
Reviewer/Inspector Name 6° mr:
Reviewer/hupector Signature: Date: 3 j UoY
12112103 1 Continued

Facility Number: — Date of Inspection j
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes X
o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Y No
❑ 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 o
25. Did the facility fail to have a actively certified operator in charge?
❑ Y j�No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
/
(ie/ discharge, freeboard problems, over application)
❑ Yes / ,�No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
[IYes No
28. Does facility require a follow-up visit by same agency?
❑ Ye m 0
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes �No
3I. 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 ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit © Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3t 391 Date or visit: 2/27/2002 Time: 15:10
0 Not Operational 0 Below Threshold
® Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: Ste..ve,.SrnixhEurw........................................................ ....------ County: I)m4ia.................................... WJR0 ......
Owner Name: t2FOl$0.----------------tth----------------------------- Phone No: 4I2:�b$=G2 - --- --------------------
Mailing Address: J.39.....f).Qdlaild.ChjLrch.R4,kd......................................................... AlbgICt on...N.C.................................. ...... ..............
Facility Contact: ........................................................... Title: ......................... Phone No:
OnsiteRepresentative: Steyr ivtit._______.__________----------------_-_--- Integrator: Q1YWs_atCar.QWja}InZ_--------------..
Certified Operator: Stpphcja..0 ........................... Smith ................................................. Operator Certification Number: dQ.978.............................
Location of Farm:
rake Hwy 903 north from Kenansville. Turn left on to Hwy 111 north. Farm is approx. 1 mile on west side (left).
w
® Swine ❑ Poultry ❑ Cattle ❑Florae Latitude Longitude 1 77 ' 49 ° 30
Number of La 1 ®Subsurface Drains Present ❑ Lagoon Area ® Spray Field Area
Holding Pondsa-Solid Traps_; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ® Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:------------- I------------- --------------------------------------•--------•---------•-----•-------------------•-----•--------------•-----------------------------
Freeboard (inches): 31
nrinainr h---•e-.-.-�

ujiwivj
Facility Number: 31-391 Date of inspection 1 2/27/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Hay) Small Grain Overseed Wheat, Soybeans
uunrjnueu
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ®No
❑ Yes N No
❑ Yes N No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? N Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records _& Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes N No
❑ Yes ® No
❑ Yes N No
❑ Yes ❑ No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #� Egpla�n any YES answers andlor any;:recommendahons or any<otiier comments
Use drawings of facility to better explain sEtuat ons�(us a ad �onal3pages as nececsaryj q ❑ pield Copy ❑Final Notes
3. There are some depressions at the riser locations of the row crop field and at the pumping station on the lagoon which are used to catch
leaking or waste runoff from the field. Mr. Smith says they will then use a small sprinkler system to put the waste back on the field from
_
e depressions near the row crop field. There was some waste escaping from the depression at the pumping location; need to contain
aste in this location and return to the system. Need to first prevent leaks and runoff from the system and use current system as a safety
ensure. Need to ensure that depressions are not holding waste prior to any rain events.
14. Need to have a wettable acres determination done for this facility with a waste plan and record keeping to match.
19. Need to use correct beginning PAN allowance from waste plan on the IRR-2's for wheat; plan says 112, IRR-2 currently has 50.
Iso I hi hl recommend recording the freeboard levels yourself as oLposed to using the service erson's readinZ as is currently done.
Reviewer/Ins ector Name
P .-
�l
Reviewer/Inspector Signature: Date: % 0—

05103101 continued
facility Number: 31-391 Date of Inspection 2/27/2002
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ®No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes ❑ No
A itlon ,-_oninientsxan .ors rawings: - d
Overall, the facility and crops are neatly kept. Z

ii0 l i= =a m
Type of Visit f0 Compliance Inspection Q Operation Review O Lagoon Evaluation J
Reason for Visit JQ Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access li
Facility Number
Date of Visit: 11 DI Time:
3 3
Q Not Operational Q Below Threshold
D Permitted [3 Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: �.. _.
Farm Name:.....S....-.......v....C.....FA e n, . County: Dm ...�............................... ...................................................... ........................ ....._ _ Owner Name: 11 ''"0t;� �1' ...... Phone No:
FacilityContact: ............................................................................... Title:.........................-----.................................. Phone No:
MailingAddress:.............................................................................. ......................................................................................................................... .. ..........................
Onsite Representative:..... S�e ye '� r -4,.................. Integrator: g^at l r1'S 4DG�t�o i i &-Lee.
................................................._........................................._....�_...__,
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse
Latitude ' 4 64 Longitude 4 69
Design Current ::
wise Ca
Wean to Feeder
y
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes PNo
Discharge originated at: ❑Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes UfNo
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? n 1
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ONO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes )-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes A No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. j........................................... ......... .
Freeboard (inches): 30
5/00 Continued on back

Facility'Number: 3 1 —3 1 Date of Inspection 1 D Il DI
_T 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?
❑ Yes O Ne
❑ Yes ,6 No
❑ Yes jd No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes JZ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 'ONo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,9No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 0No
12. Crop type W heel So�16eg►�,51�3errrtvdaA-ter , 5..,�1i /,;Warn
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ZNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONo
b) Does the facility need a wettable acre determination? ❑ Yes flNo
c) This facility is pended for a wettable acre determination? ❑ Yes P No
15. Does the receiving crop need improvement? ❑ Yes 0 No
16. Is there a lack of adequate waste application equipment? [I Yes ,fNo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes Z No
l8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes ]2fNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes j2rNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 21No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes EjNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes WNo
24. Does facility require a follow-up visit by same agency? ❑ Yes kNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes jJ No
Y;plaW4s:off d :4101 ie vv re pQte dung �h4s:+'�s� Yoa w: I teo i ii tj fu4 t. Or . .
. - . - 'corresnotideace: abotitithis :visit` • .....:.: :. : :: : :............... :.: :: .
to-li
71ce fat i t i.�y i recp,rGlS y Q c.��S �tr� {7ei►� l'�a;+1{qi�t?� i►1 Art
�x��Ien1 Ca�:a�`o�►. 1
A.
Reviewer/ins ector Name
p netn��fl-►1�;5
Reviewer/Inspector Signature: Date: / 0 1(V Q i 5/00

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
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 1( 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 zNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes effNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
[Additional Comments and/or rawirw:
5100

X-Division of Water Quality
O Division of Soil and Water Conservation _
O Other Agency
Type of Visit `Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
jDateoFVisit: Q r iiQ 'I-ime: i =�� Printed on: 7/21/2000
3 !
0 Not O erational Q Below Threshold
Permitted © Certified © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ................
Farm Name: ...............11.e...........................'...?...�................................. ' ...I>U..............................................................
�^ e .5 � ,r ✓�'. County, .. !,; ►'►
.......................
OwnerName: <N O mG Y1 'S!"'I a..�..�...... Phone No:...................................................................................... .............. .........................................................
FacilitvContact: ...............................................................................Title:..................................................... Phone No:
MailingAddress: .................. ...........................................................................................................................
r
Onsite Representative: _� eve Sm'... , "1..... lntc trator:.......'r �t"'J � s L/7 Ce�G1'�a r c►
.................................................................... ` ..............
Certified Operator: ................................. ........ Operator Certification Number:....................
Location of Farm:
[]Swine []Poultry []Cattle ❑ Horse Latitude ' 4 =i Longitude 0 6 °t
Design Current
Swine Canacitv Population
❑ Wean to Feeder
ff-Feeder to Finish
Z ! UO
150
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-�nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes %No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 19No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes 9No
c. if dischart�e is observed. what is the estimated flow in gal/min? n a
d. hoes discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P5No
Structure I Structure 2 Structure Structure 4 Structure 5 Structure 6
Identifier: ...............� ................ .................................... ... ................................
Freeboard (inches):
5100 Continued on back

Facility Number: Date of Inspection' f /I ��_ ono I Printed on: 7/21/2000
"5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes g'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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?1 ❑ Yes 19 No
11. Is there evidence of over application? ❑ :PAN Hydraulic Overload Yes &VNo
12. Crop type fie,,-r.yAG boot ,5;%g1] Gy-yt;n. iJ heal , ,Sad tann
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
IT Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0; N,6-yiol;atigfis'0- di f cieneies -were .h6 ed during this;visit: - Y:oik ;W RI •i-&OW fio further ;
rorresponde'& abou>k: this Visit. ' ....... .... .... .................... ....
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J9No
❑ Yes KNo
❑ Yes V No
❑ Yes JgNo
XYes ❑ No
❑ Yes �5No
❑ Yes ;K No
❑ Yes No
❑ Yes j No
❑ Yes 9No
❑ Yes $No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
%. wo ek -to C-04 A >y¢�tZ7q4:dPon 6qf� cr'eots vn Gr,ck Bldg l�,yOOi'}, l
19_ Vje A��,�a�an a-�-� wJ✓as�� �n�l sus oh ��°�- Z -far s,'vs� 'nY7 f
- Ai4e-d w,-14 � z, 60 d� S a ��Q%1 o4;ei-, Use n n i nq
,�. PAN all 0WAr?Ge- rcw� �txS J
ti . Qvc�4pP�1'G i6Yt f AIL% an 1 Z000 oveese-ed a 849 jtgitore ¢n
i 0. J�U%1 Z a)14 °'f l 1q` ZOOOave---ce 4 W 9911 b5luvre sm F-jdd Z fal7.
Reviewer/Inspector Name S:- ,, me ca 4 t ? Ma4 4-, f
Reviewer/Inspector Signature: _ J / Date: `)// 17109a $/pp

Faclity Number: Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or hvlow ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 19No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes LffNo
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 )5 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
J
5100

Q Division of Soil and Water Conservation -"Operation-Review 2
s
13Division of Soil and -Water Conservation - Compliance Inspection
®Division of Water Quality'- Compliance Inspection
_.
© Other.. Agency - Operation Revie' w
Routine 0 Com taint Follow-u p of DWQ ins ection O Follow-u of DSWC review Q Other
Facility Number� �
Hate of inspection
Time of inspection 24 hr. (hh:mm)
Q Permitted 0 Certified Q Conditionally Certified Q Registered Q Not () rational I Date Last Operated:
Farm NTiIrnC: S�t.ve......$,c�:►..lY County:.....vla*.?'........................................ .......................
.................. ..................,..j..........-....-..........-.-..................... l
KL
Owner Name: ....... ��t�nkilt�...............
........ sc\.�lr:-................................................ Phone No: ..�.... {�'��..-Si+t���70C�...............
....
Facility Contact: ..,rSTu! -...-.�........-...p......
MailingTitle................•. ............... Phone No:...............
Mailing Address: ......i5`.Z.......Q�G1All.......tp
tf/�tl�t[V4.........�t1.�....................... .Cr...................................... ..r�i.......
t....
jj�
Onsite Representative: ...5.�L.1?t......sftY — Integrator: ...........................................................
Certified Operator: ... ............................................... ........ . ................................................... Operator Certification Number:..........................................
Location of Farm-
...............
0.^......tetS.5.........s?t .c...,<............(1 ......10 ..c.l!..val --- !Ir ..s.....!1ar....... a......� l r.1�....1�..:...............................:............................................
......----..........................................................................................................................................................................................................................................................
Latitude �•�� ��� Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder r❑ Layer JE1 Dairy
Feeder to Finish U p lj❑1Non-Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ) ❑Other
❑ Farrow to Finish Total Design Capacity Zf a
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Subsurface Drains Present ❑Lagoon Area pray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes ® No
h. if discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes ® No
c. if discharge is observed. what is the estimated flow in galhnin? �
d. Does discharge bypass a lagoon system? ❑ Yes 1 14 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [M No
3. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes k No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate'? OYes ❑ No
Structure I Structure 2 Structure .l Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
1/6/99 Continued on back

Faci ity Number: 31 — 3�( 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 top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
3 �
❑ Yes ERNo
1 I. Is there evidence of over application? ❑ Po`nding ❑ Nitrogen
12. Crop type .......bexy!^! k......... ........... 5'.w1 � f!!. W 1
11Y1 ............................ ?...........................................................
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement'?
lb. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
1 S. 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? (ic/ 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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ® No
M Yes ❑ No
❑ Yes [RNo
❑ Yes M No
❑ Yes Pq No
❑ Yes q No
❑ Yes 0 No
Jj2 Yes ❑ No
❑ Yes R No
❑ Yes [51No
❑ Yes N No
❑ Yes No
`@] Yes ❑ No
❑ Yes No
❑ Yes JE1 No
❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [J No
24. Does facility require a follow-up visit by same agency? Yes ❑ No
3: N.0.viatations:or. deficiencies were noted during Ais:visit.. V-6u wili're-ceive niY further
correspgtiidence:abbutAhis visit.:•:•:•:•:•:•:•:•:•:•:•:•:•;•:•:•:•:•:•:•:•:•:•:•:•:•:•;•:•:•:•:•:•:•:•:•
Comments (refer to question # ): Explain any YES answers and/or any recommendations or, any other comments
Use dcawings'of facility, to better explain situations. (use additional pages as'necessary): ;
. I.a.oc:• (nar+ insv i�i tpga0�+ ltv,( be toWttt{) ;c. Ves�orS,16U ^4.4-ir+-i Ak.
�•av+ ]]+t.t.� � e. ��{� �o ve.���ait low J) o�os o v� l a��ar� d;1i'..� r..�.(L • `
1. CorjtA
w A yt, . on t u%% ' oi�DW►�`j cow. be Puoitt�ecJ �Y '��'d-�qq:
ILA. 51,r, WAk �e Gs�9�a d k�Aa�-k
WUl •I* I:S U5S �S°7o 0�-!\a"-4�-)e 0r rt,4_ C,-d) Q6, i� 0-ft
lg. fvi�roq .,, t s 560'0 h� ccztw it-W Us In �4, Ibs/cae- laA.)� Mal
1 s,nal( vA',r• o�r eei , Pyp� er P1�1 rh"" ' "� , 1n� �re��'%� 4-- was I-e
u���:Lg�t1o� {3 vFC i skou\ 1 be- v� CL.,'� }a N GS t1 �r� rUrr•ahen.
Reviewer/Inspector Name lt ij
- -
Reviewer/Inspector Signature: ` Date: 3 1 q
r9 11/6/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
J@ 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 2 , , 24 hr. (hh:mm)
13 Registered 13 Certified [3 Applied for Permit © Permitted 113 Not Operational Date Last Operated:
FarmName:...............S. &. S. MLik..... Ttirw......................................................... county: ...... b4t)lh,........................................ .......................
Owner Name: .......................... M°!ry"A w.... ..------.� ff'.'............---...---...................... Phone No: ....CI10.S.& ............................................
Facility Contact: .................. S�6.1 L........... .:h............. Title:............... ......... Phone No:
Mailing Address:...............uArid .......5 uf4 ....... gj ............................ ......... f1i ??:rry....N.4....................................... ...z T.......
Onsite Representative: .............. .......................... �icr.A
.. Integrator:,.......--�r.'lx.�:
Certified Operator:............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
i�dt�S.....a.i......4.........1-1ta�...}..S...m,.......Y>Qr �....+a f....�,►...1..............................................................................................................
IV------------------------------ ...----............................................................ I ...................... I ...........................................................
Latitude a=' =11 Longitude r��• �' ={G
Design :. Current
Design Current Design Cut reniE
„Somme Capacity F4&lation
Poultry
Capacity, Population Cattle -;; CapacityPopulation ..
❑ Wean to Feeder
; ❑ Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer ❑Non -Dairy
Farrow to Wean
❑ Farrow Feeder
❑Other
to
❑ Farrow to Finish
Total DeStgn Capacity
❑ Gilts
"
T©tal SSLW
❑Boars
,
Number. of �a¢oans / Hol��n¢ Ponds
O....
Subsurface Drains Present ❑ Lagoon Area
Spray Field Area
R.
.. .....
a
No Liquid Waste Management System
y
_vim_ G s❑
e
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ($1 No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes q No
c. If discharge is observed, what is the estimated flow in ,alhnin? Allk
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes C1 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes (A No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 119 Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes rtn -i No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes (A No
7/25197

jfafifity�iumber: 31
8. Are there lagoons or storage ponds on site which need to he properly closed?
Structures (Lap-oonsJlolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
El Yes $3 No
El Yes 19 No
Structure I Structure 2 Structure 3 Structure 4 . Structure 5 - Structure 6
Identifier:
Freeboard (ft): .............
.1 ............... .................................... ................................... ........................
10. Is seepage observed from any of the structures?
I I. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
ar any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WNP, or runoff entering waters of the State, notify DWQ)
- 1K15. Crop type ............. ....................... V.4v#.& . ............. W .. 4:1S .................. ............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities OnI
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 AWNT?
25. Were any additional problems noted which cause noncompliance of the Pcrm�it?
...................................
...................................
0 Yes ED No
0 Yes No
NYes No
El Yes No
El Yes No
[3, Ndvioilaitiohs'- or' d6ficie'nc'ie's."w'e'r'e-ho'tid-du'ritig'-this'.Visit'.- Noii-m-ill _re_cii've'_n6-f&ther','-
.......... ­­­, ......
........ .. ..........
COI'rOPOfideike tihoijt -this'.
W Yes [I No
0 Yes FuNo
YW
0 Yes U1 No
0 Yes [K] No
QtYes 0 No
Yes No
Yes No
El Yes W No
El Yes Nal No
7—
El Yes P No
tj ItSO
),,Z, &)C.SV_ %C%.vv*LX 5AUujj 16-e A rz
Ok WL)?.
7125/97
Reviewer/Inspector Name 1WRE
Q� �
Reviewer/Inspector Signature: 7%&A-
Date:

Date of Inspect ion
y Number
91
Time of Inspection 24 br. (hhunm)
13 Registered ;5 Certified 13 Applied for Permit E3 Permitted JEJ Not Operational I Date Last Operated: ..........................
Farm Name: ........ 15 Rve .......... 5M, -k: tlk ........ 11:;�. Countv: ....... ...................................... .......................
O-vvner Name: ........... 5.1a . .......... ........................................................................ Phone No: ... .......................................
Facilitv Contact; ........ 5�'e .......... SM.-A . ........................ Title O.W
........................................ Phone No:
Nlailing Address . ......... ......
....................... ...... 4x& . ..... ...................................... zs.!F.zy ........
Onsite Representative: .......... ........... ....... ............. ".." .... --.- Integrator: ....... gnuiN'.�i ...........................................................
Certified Operator ........ ......................................... ............ ................................. .............. Operator Certification Number, .... ..............
Location of Farm:
... To t -I.. . AL
............
V....... !Qi?!� ...... 4�� .... W.Ae ................................................................................................................................................. — . .................
Latitude 40 1 .9 Longitude 4 4�
Design Current
Swine CaDacitv Povulation
Wean to Feeder
Feeder to Finish
Farrow to Wean
Far -row to Feeder
Farrow to Finish
Gilts
Boars
Design ' Current Design Current
Poultry Capacity Population Cattle 'Capac#y. Populadon
ID Layer I El I
JE3 Non -Layer I I I0 Nori-Dairyl
Total Design Capacity. '7-
ID Other I
Total SSLW I -
Number of Lagoons Holding Ponds JE1 Subsurrace Drains Presen:t]10 Lagoon Area ID Spray
rO 'N7o Liquid Waste Management System
General
1. Are there any buffer-, that need maintenance/improvernent? 19 Yes [I No
2. Is any discharge observed from any part of the operation? 11 Yes [ZNo
Dischar-e ori-inatcd at: El Lagoon [I Spray Field El Other
a. If discharge is observed, was the conveyance man-made? El Yes to No
b. If discharge is observed, did it reach Surface Water? (11' yes. notify DWQ) El Yes FK[ No
c. If discharge is observed, what is the estimated flow in val/min? fo
d, Does discharge bypassa lagoon systein? (If yes, notify DWQ) El Yes fA No
3. Is there evidence of past discharge from any part of the operation? 0 Yes N No
4. Were there any adverse impacts to the -waters of the State other than from a discharge? 0 Yes �kNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require El Yes ONNo
maintenance/improvement?
6- Is facility not in compliance with any applicable setback criteria in effect at the time of design? El Yes lPqNo
7. Did the facility fail to have a certified operator in responsible charge? [I Yes W No
7/25/97 Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lai!oons,tiolding Ponds, Flush Pits, etc.)
9, Is storage capacity (freeboard plus storm storage) less than adequate?
M
0 Yes 19 No
El Yes &No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): .................. .................................... ................................... .................................... .................................... .....
10, Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the intearity of any of the structures observed?
12. Do any of the structures need maintenance/im prove ment?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application9
(If in excess of WMP. or runoff entering waters of the State, notify DWQ)
C,
15- Crop type ........... CMS4� �.elrm]Ja .... ....................... sembeaw
-1 ........ ..................... J..%Jp . . ............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP))
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'!
C,
For Certified or Permitted Facilities Only
23. boes the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.viola'tions 'or' de'ricie'nc'i'es.wer'e-no-ted-d.uri'ngthis'visit.-.Yo'u.'w'ilI recei've' no ftirth'er'
... ..... . .
cf)&O�pi)fideh�e AboiA this,visit'.-,,
...............................
0 Yes MNo
0 Yes 19 No
�a Yes [I No
El Yes r*2- No
El Yes X No
El Yes 10 No
>IV
0 Yes MNo
0 Yes W No
El Yes %No
Yes No
0 Yes No
R Yes El No
C1 Yes K No
C3 Yes M No
C3 Yes D9 No
�YESanswersan dranyrecomm ons or,any.,Qj er commen
Eiplainany' d/J 6nditi' is
........ ...
eUsi dra� s of fi6lity tobeiter explain situatibris. (use AdditionaLoa.ges asneccssarv)-i
Jk )��Aer Ort? skoA �e -caJ4 alon� �;Ack o,+ eh) &f- -szj6r% -Cidd,
Cvx6�&, a.�,xas on oj� "11 OT 14�00i, -.56UP 6- Pow C)AY &J rCSeedfd,
J_jLTc4A .5�o�3 Ise- nwoed. 8,K, Qw� shoujj '6e, tcsteAej.
U. ispml rt"rk .56UP 6e, It 6 y rur\ numbeir oJ ��IJ " 6er E8>1 Y) fl..(_
jgg-L. Q� � �, w0ince '6�3 I.-! V?&4j OwilX1 a,�j it*-'k
ak� 1y; i-5 bt 01IN pleill,
Rvn ojvmjnvm pzpt. ac4vss back Coa,-Q �ItJJ - 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Af,;__Z1. Xk.� Date:

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
Steve Smith
Steve Smith Farm
302 Woodland Church Rd
Albertson NC 28508
SUBJECT: Operator In Charge Designation
Facility: Steve Smith Farm
Facility ID#: 31-391
Duplin County
Dear Mr. Smith:
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919/733-0026.
Sincerely,
A. Preston Howard, Jr., P. . Director
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P,O. Box 27667.
Raleigh. North Carolina 27611-7687 N%)CAn Equal Opportunity/Affirmative Action Employer
Voice 919-715-4 100 1 2Y M _-_2 50% recycled/100k post -consumer paper

A�%
Site Requires Irrirnediate Attention: Y
Facility No. 3.9J
DIVISION OF EVT�qRONIYENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE7 _,1995
Time:
Farm Name/Owner:
Mailing Address: q Z_ knvo /,qj /--3 At b 2 1? .5-6-6/
County
Inte ator-
(?;A. JP_n I I Z-�;CPhonr,:
Phone: - z 1� y <711,
On Site Representative:
Physical Address/Location:
Type of Operation: Swine Poultry — Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number. ACE DEMi Cerdfication Number: AQNT_W
Latitude: 0:3 LonEitude: _27 Z-1 Elevation: Fee,
Circle Yes or No
Does the Animal Waste Laszoon have sufficient fre-.board. of 1 Foot + 2-5 year 24 hour srorm event
(approximately I Foot + 7 inches) 0orNo Actual . Freeboard: Fc. Inches
Was any se��pagt observed f�om the lasoon(s)? Yes 00 Was any crosion observed: (9-1 r No
Is adequate land available for sprav?(�r No Is the cover crop a&_quate? (!�r Ro�
Crop(s) being urilized:__iF�Iur
Does the facility inett SCS 1111inimurn setback crilieria?. 200 Fef�t from Dwellings?(�r No
100 Feet from Wells? e T 1NO
Is the animal was:e stockpiled within 100 Felt of USGS Blue Line Stream? Yes
Is animal waste land applied or spray irrigated within 25 Fee,. of a USGS iNlap Blue Line? Yes or(&D�.
Is animal waste discharged into waters of the state by man-made dicch, flushina sys:�-_-n. or other
similar man-made devices? Yes ordq
'If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes oE manure, land applied,
S-Oray -ated on specific ac-reagev�riffi cover- crop)? (Nor No
Additional Comments: -_;�CAx &LA_ 6,,�i a -1-5
26
A_)E6P. , /d 4, 5 -7 Al—
M � -o e c t o r -Marn e
cc:-Facihiv Asse�;snienr Unit
If Nec-ded-

a
Site Requires Immediate Attention: A55
Facility No ij I -;'Alq 1
DIVISION OF ENVIRON�/MNTAL MANAGEATENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
-DATE: __Z_45 _,1995
Time: I r"ary I
Farm Name/Owner: r m z., �:)M 107
I&L ;9rxj',?
Mailing Address: 13cl bk)0CXR_M UrtA �49rl_50fl ML 285DeL
County: — a.)/)/,
Intearator
5
On Site Representative:
Physical Address/Location: 60/�t
W
Phone: Zc�'3' 3(000
Phone: 9 19 — 5618 — 3 3(0�
neCi-A4.
Type of Operation: Swine '-� Poultry Cattle F-) /I I -5ri 117
Design Capacity: t ((aQ . Number of Animals on Site-
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: * 4 .3 Elevation- Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm evenr
(approximately I Foot + 7 inches) (��br No Actual Freeboard: _:��__FL Inches
Was any seepage observed from the lagoon(s)? Yes Was anv erosion observed? �e>sr No
an- 01E r No
Is adequate I d available for spray? (fe is
. >r No over crop adequate?. 6es>
Crop(s) being utilized: C 0 9 EL-2- I
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (De or No
100 Fee,, from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 0 60)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Mal) Blue Line? Yes o
'7
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-
r(90
Does the facility maintain adequate waste manag ement records (volumes of manure. land applied,
re with cover crop)?
spray irri ated on specific acreag e r No
Additional Comments: (&� V'� back . 5 kv e 0-r
_4F - 0y-0 5)'o4 on - 4b /)
L. L
Inspector Name
cc: Facility Assessment Unit
�- <;f -Z bj
Z4�
signaniLre
Us,:� Attachments if Needed.
.1