310392_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quai

Type of Visit: V) Cojnpliance Inspection U Operation Review U 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: L,111 11T Arrival Time: ® Departure Time: County: ooaaj Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: -eve yyyttr�
Certified Operator:
Title:
Phone:
Integrator:
Certification Number: 811
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design C+urrent
Capacity Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
"eder to Finish
Farrow to Wean
Desigu Current
D_ P,oult , Ca aci Pao
Dairy Heifer
Da Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Layers
Gilts
Won -Lave
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
[DNA
❑ NE
❑ Yes o
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I , Structure 2 Structure 3
Identifier:
J..dCl.-wi
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes] No ❑ NA ❑ NE
❑ Yes M] 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 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 Wo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 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 bel
[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 ENo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes EyNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

[Facility Number: - Date of Inspection: a
24. Did the facility fail to calibrate waste application equipment as required by the permit? 7 ❑ Yes [ o ❑ NA ❑ NE
25As the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the 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
�o
❑ NA
❑ NE
❑ Yes
�/o
❑ NA
❑ NE
❑ Yes
❑ To
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #):;Explain any YES answers:and/or any additional recommendations or any otherSomments
Use drawines of facility to better explain situations (use additional nacres as necessarvl:
21) Gcr 59L, AtJALVT1;_0'1r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
uExT 36 Pa&
Phone: Ifs r r / 3
Date:
21412015
i

Type of Visit. Z) Co¢pliance Inspection O Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: © County: 1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
n
Onsite Representative: VE- VyNn+k Integrator: j n
Certified Operator: Certification Number: ! 9
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design
Swine Capacity Pop. Wet Poultry Capacity
Wean to Finish Layer
C►urrent
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D . P,oul Ca aci
La ers
Current
P,o
DairyHeifer
Cow
Non-DaiEy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and 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?
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 /NNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes ❑ o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Condnaed

Ii'acili Number: IDate of Ins ection:
Waste Collection & Treatment
i4. 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
rcture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 6.,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I /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 environm21X'o
I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes qNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.).
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
r
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �Z
❑ 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 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 o
[DNA
❑ 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?
❑ Yes rNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: jDate of Inspection:
•24. Did the facilityfail to calibrate waste application equipment as re aired b the permit? Yes YNo
' NA NE
PPq Y P ❑ ❑ ❑
5. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]Yes No
❑ Yes No
❑ Yes ZNo
Z111-
❑ Yes [>e. ❑ NA
❑ Yes '[ ❑ NA
❑ Yes No ❑ NA
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NE
❑ NE
❑ NE
(Comments (refer to question f): Explain any YES answers and/or any, additional recommendations or any other comments. I
Use drawings of facility to better_explain situations (use additional pages,.as necessary)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
,A
Phone: C b 116 b 9
Date: �K_/(J
121412615

Type of Visit: U Com ance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
r r
Date of Visit: ]j5 /� Arrival Time: I IT Departure Time: Z , r, County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title: Phone:
Integrator:
Certified Operator: Certification Number: 1 9 2Z�_
11
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
Layer
Design Current
Capacity Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
can to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish rz t t.
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
MDesign
D , P.oW
Layers
Current
Ca aci P ,
Cow
Non -Dairy
Beef Stocker
Gilts
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 EjNo ❑ 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 ❑ No
❑ Yes E�
❑ Yes rNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection: /S
Waste Collection & Treatment
No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q
❑ 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): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
12/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
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
dNo,
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[D"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
E 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
0 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
*/
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E_N'o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ 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
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 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

Facifi Number: jDate of Ins ectioo:
24! Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No,- ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F3/No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ErNo ❑ NAB ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 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 [Do ❑ 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 CTNo ❑ 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
❑ 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 O No ❑ NA
❑ Yes
❑ Yes
❑ Yes
No ❑ NA
tom ❑ NA
❑,<o ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

i R�mS ✓
(Type of Visit: (9 rRoutine
piiance Inspection V Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit:
Farm Name:
Arrival Time: 0 Departure Time: / Th County: Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Sr±Jt 513A=4 Integrator:
Certification Number: I 1V F
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C►urrent
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
aci
Layers
Dry Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
as
Turkey Poults
Other
Beef Brood Cow
Other
OtherL
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - jDate of Inspection:jn y
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes {nNo DNA ❑ 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 d ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
I L 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
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesVNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ZfDsludgeSurvey
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
21412011 Continued

Facility Number: -T�E]Date of inspection: - , rr
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ej/Nc ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I ,ENO ❑ NA ❑ NE
the appropriate box(es) below. TT
❑ 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesF2'<o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes 0 /No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2 <No❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ YesVNo❑NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other cominents.
Use drawings of facilitv to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �lt) 3 f0
Date:
2741241

Type of Visit: U7Routine
pliance Inspection U Operation Review U Structure Evaluation p Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: ® Departure Time: 62a County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: S'TLV___ sNtm Integrator:
Certified Operator:
Phone:
Certification Number: 9 7 p
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
MEMEMILD Current
Capacity Pop.
Finish
rUWean
Wet Poultry
La er
Non -La er
Design Current
Capacity Pop. Cattle
DairyCow
DairyCalf
Design
Capacity
Current
Pop.
Feeder
o Finish 2
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Di, F,oult .
La ers
Dairy Heifer
Design Current Dry Cow
Ca a_ci_ P,o _. Non -Dairy
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes M No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 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
t3 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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
[DNA
❑ 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
3No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
6 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
[;j 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
[l]�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
Ef] 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
o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
�WN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ 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. ❑YesEj No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[] Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 31 _31 Date of Inspection: t 3
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N ❑ 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
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
JNo ❑ 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
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately,
YNo
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
L_-I o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�/No [] NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [;)jo ❑ 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:
Reviewer/Inspector Signature:
Page 3 of 3
C^t N Phone: b _3110' 7
Date: V
1 3
214120I

Type of Visit: ir70,
iance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit:tine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: �r,�{e Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: S ►e /G S h'f; Integrator:
Certified Operator:
Phone:
Certification Number: 1 { f l 1
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultiy
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Da' Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
C+urrent
Dry Cow
Farrow to Feeder
Dr. PoW
Ca aci
P,o ,.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes VN
❑NA ❑NE
❑ Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of inspection: y (c,
Waste Collection & Treatment
4Js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ 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): O" J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes f[No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes � ❑ NA ❑ NE
❑ YesrNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes CZ No ❑ NA ❑ NE
[]Yes <o ❑ NA ❑ NE
❑ Yes rNo
� ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 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 ]No NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

ification?
❑Yes No
❑ NA
❑ NE
Other Issues
2$. 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.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
[—]Yes No
❑ NA
❑ NE
Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes [/"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesF3</o ❑ 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 0 o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes dNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus lass assessments (PLAT) cert
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 CAWNIP?
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
❑ Yes
❑ Yes
oD
NA ❑ NE
NA ❑ NE
NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use "drawings of facility to better explain situations (use additional owes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
—?3
Date: Date: IL.,/
2/4/20I1

- IV1SIOn O ater uahty '_ 'a
Facility -Number D n of SosH and Water Conservation b
rvisio
0 Othcr A enc
g Y
Type of Visit Co fiance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: )_�Je�,_ Region:
Owner Email:
Facility Contact: i Title:
Onsite Representative: STef]6j cSry'E0--1'1
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 6 = 4 Longitude: = ° ` = "
= Design Currcnt
,� kDessgn
Current "" Desgn Cn'r�ent
_�. .
Swine , Wet Poul ti A Y
Capacity ]Populahon try Cap city opu a e `°`
fl a P lataon. Capaci Po Matson
Wean to Finish
❑ Farrow to Feeder
Boars
❑
Feeder to Finish
El Farrow to Wean
❑ Gilts
Wean to Feeder pi
❑ Layer El Dairy Cow
�
❑ Non -Layer -. ❑ Da' Calf
Discharses & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Layer El Dairy Cow
�
❑ Non -Layer -. ❑ Da' Calf
Discharses & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ Na
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes / No ❑ NA ❑ NE
❑ Yes �N/o ❑ NA ❑ NE
Page 1 of 3 I2/28/04 Continued

-F'aeility Number: — Date of Inspection
rrWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I ] Structure 2 Structure 3 Structure 4
Identifier: CA 2rz�r✓
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 UNo
❑ Yes ❑ No
Structure 5
❑NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;No
ElNA [:3NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ElYes ❑ 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 W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l o lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
� El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes7L:juo
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NA
❑ NE
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
Comments (refer to question #):=Explain any-YES-answers:andl©rany,.recommendations or any other comments { ,
Use drawings of facility to better explain situations. (use additional pages as necessary):' ' "{
i
ReviewerlInspector Name �'H j
Phone: 0
Reviewer/Inspector Signature:
Date: 1
Page 2 of 3 4 12128104 Continued

:f
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes ' o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other !!
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D o ❑ 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
[2'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
- ❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
j1J No
❑ NA
❑ NE
27,
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2/No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[2/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative in mediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
WNo
❑ 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
tad No
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: k
Page 3 of 3 12128104

Type of Visit &Corrmlliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit W Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: oZ f t7 Arrival Time: Q(] d Departure Time: County: iP(. Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: 1 Title:
N
Onsite Representative: <T-e- ed yhtz-I t-1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: =n =' =" Longitude: =° 0A =u
DesiIfficurrent
Design
Current
Design CurrentCapapulation
Wet Poultry
Capacity
Population
Cattle Capacity Population
❑ Wean to Finish ❑ Layer
❑ Dairy Cow
Wean to Feeder ❑ Non -Layer
❑ Dairy Calf
Feeder to Finish WJ60 2j &o
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish ❑ Layers
❑ Beef Stocker
El Gilts ❑Non -La Non -Layers
El Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkey Pouits
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ El
❑ NE
❑ Yes
El Yes
ElNA
El
El NE
El Yes
No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection oZ 1 ID
`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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes EJ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) thrpt, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Eallo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Rio ❑ 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 ldNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EJ Zo ❑ 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
E7 N
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No
❑ NA
❑ NE
l o!Dm Tents, (r`efer to question,#y Explain any YES `an"swei s and/or any`recom endations or any other comments:
Use drawings of facility to better explain situathons. (use`additional pages as necessary):.
Reviewer/Inspector Name A) �' L " Phone: /� % — &ff
Reviewer/Inspector Signature: L, , Date:
12128104 Continued

I
Facility Number: — Date of Inspection is
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 40
ElNA ElNE
❑ Yes 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 1"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
EfNo
❑ NA
[INE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
ETNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�n
[:1 NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
�f
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
N
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
EJ'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
L"J 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?
[I Yes
��,,!!
El o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Ck<O
❑ NA
❑ NE
12128104

3
Type of Visit Cor�npliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for VisitQ�/Routine Q Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 1 i% 09 Arrival Time: Departure Time: h.� County: DUO 1-1d Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: e7y'mt smj Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o [= I [= Longitude: = ° = 6
Design Current SE
Capacity Population Wet Poultry
❑ Wean to Finish ❑ Layer I
❑ Wean to Feeder 10 Non -Layer
urrent Design C►urrent
RSineufation Cattle Capacity Population
I
❑ Dairy Cow
❑ Dairy Calf
Feeder to Finish
jy
d
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
IOther
Dry Poultry
❑ La ers
Non -Layers ers
❑ Pultets
[:]Dry Cow
❑ Non -Dairy
El Beef Stocker
❑ Beef Feeder
ElBeef Brood Co
El Turkeys
❑ Turkey Poults
❑ Other
Number of Structures:
IIE] Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
❑ NE
❑ Yes
El Yes
FV0 ❑ NA
ElNE
ElYes
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facilgy Number: — Z
Date of Inspection / 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
St e I. Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
2
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental)
notify DWQ
threat,
7. Do any of the structures need maintenance or improvement?
❑ Yes
ILJ o
El NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Zo
❑ NA
0 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 WNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Z�,No ElNA
❑NE
❑16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?Yes
o ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
o ElNA
FNo
ElNE
18.
Is there a lack of properly operating waste application equipment?
[IYes
❑ NA
❑ NE
`Co enIQ(ref q e on #)' Ezp aio any YEkS a wer a d/or a�ay recommendations or any other comments.
Use.dhawin� of aacm ,tobetter�egplain�ptuanons (use addMonal pagestas necessary):
Reviewer/Inspector Name j,/ ((, Phone: 710 k
Reviewer/Inspector Signature: Date:
Pn40 7 of 3 12128104 Continued

Facility ]lumber: 1 .-3721 Date of Inspection d
Reapired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes diNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [' No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V
Rain InspectioVNo
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
j2<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EIo
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
U1111O
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�10
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U40
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNNo
❑ 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
LI No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L"J Flo
❑ NA
❑ NE
Additional Comments and/or Drawings: _.
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number 3 3c`1e2 0 Division of Soil and Water Conservation
Other Agency � g Y
Type of Visit ; Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (9) Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /Q �� Departure Time: �� County: �Lt�u� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: S T Gu G. S m t r �.4
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: I Back-up Certification Number:
Location of Farm:
Latitude: = o = ❑ Longitude: ❑ ° = ,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish o11{a0 1A 1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
LEt Non -La es
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
Urkey Poults
❑ Other
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current+.
Capacity Popula.0.61k �.
El Dairy Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
❑fF d
Be
ef 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 ffNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
ED-No
❑ NA
❑ NE
12128104 Continued

FacilityNumber: 3 — 35a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RR 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: -)cxzW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R 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
CqNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
RNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [j 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 f5�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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
En No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ECI No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
� No
El NA
El NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name j9fflowog Ga/.vC� I C—Ti..- G, i Phone: 910-'}`1%—��$�
Reviewer/Inspector Signature: Date: ) //
121Z /U4 uonunueu

Facility Number: `j y - 3 Date of Inspection 1 O
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Qfl No ❑ NA ❑ NE
the appropirate box. ❑ wup ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ 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
[B No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V1 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
[a No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
13 No
ERNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[M 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
EQ 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
[M 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
U No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

O Division of Water Quality
Facility Number 'j 3 g ti O Division of Soil and Water Conservation v/
Q Other Agency
Type of Visit 0 Co fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �% t! 0 Arrival Time: Departure Time: County: i)U)0tJW Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: SMIIAEtJ _�M.3Tji Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ 0 0 , = , Longitude: ❑ o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischartres & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity . Population ,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
El
El
Beef Feeder
Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
El NE
El Yes
,_9(No
C� No
❑ NA
❑ NE
12128104 Continued

Facl ility Number: I — al- Date of Inspection
t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
��/
El Yes L✓J 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: �A X�LfU►J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes IJ 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 Ld 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 dNo ❑ 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 [INo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E3"No ❑ NA ❑ NE
maintenance/improvement? ,,(
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L_I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E]�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
d o
ElNA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t�J 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):
SI.0 n GF I M- ✓66P o 0- L 46 6 OOT TAT 4241' ff4-0 "D &rt P r T# RFi;t'!6 v/; L
PZANf
� q
Reviewer/Inspector Name Vohlu L Phone:C
Reviewer/Inspector Signature: Date: D
1 12128104 Continued

kacility Number: /� — �,2 Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 90
El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
FNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ld<o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,�l,dNINo
o
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,IJ
LdNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
U o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
eNA
❑ NE
Other Issues ,.,/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L� No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
E 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
dN o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

%7 Division of Water Quality .
Fae lity Number 3 30 Division of Soil and Water Conservation
Q Other Agency
hype of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
(94outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: EYET&O Arrival Time: ill UA Departure Time: County: 1) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 5TEVC- .�M:g:W Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0[ 0 Longitude: 0°= N
Desigq Current Design Current Design Current''
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacityr Population°P
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
1 U
CIO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
`
If
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
s
- Number of Structures:—`
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
El Yes 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
o
El Yes
Yl�o
❑ NA
❑ NE
❑ Yes
N o
❑ NA
❑ NE
12128104 Continued

Facility' Number: 3 — 39z Date of Inspection a bb
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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 606)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ool
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes .6 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 I� 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? El Yes 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 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) J E /4 rnvPA (14) S G D
13. Soil type(s) a ArgLK
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
[) No
ElNA
ElNE
17. Does the facility lack adequate acreage for land application?
[IYes
M// No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2No
❑ 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.pecessary):
a �
Reviewer/Inspector Name F_ 46 0. Phone: + " 7 6 S-
Reviewer/Inspector Signature: Date: b
Page 2 of 3 I2128104 Continued

F261ity Number: 3 — Date of Inspection 03. 01.Ir
Required Records & Documents ,�/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes
�+ N El NA El NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes L� No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EfNo ❑ 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
[YNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EYNo
❑ 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
ZNA
❑ 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
❑ No
[(NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�f
L'� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,�/
L1 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
�,`_
LJ'N o
❑ 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
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Comments and/or Drawings: . .
Page 3 of 3 12128104

Type of Visit �Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / O Arrival Time: I��7 Departure Time: County:
Farm Name: !�✓ �lj'I��frL�Qrl'Z Owner Email:
Owner Name: ✓% 2! Phone: _
Mailing Address:
Physical Address:
Facility Contact: /�. Title:
Onsite Representative: -�! �Z✓ �/i1��
Certified Operator:
Back-up Operator:
Phone No:
Integrator: 41
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: =] e FT [= Longitude: = ° =' = "
MIS
Design Current'.
Design Current
PAR
Design Current
Swine
Cap ty Popula025 Wet Po;ulti�
Capbac sty Population
Cattl eie Cap ty;.Population
❑ Wean to Finish
" ❑ La er
`
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La el
❑ Dairy Calf
Feeder to Finish I
V
❑ Dairy Heifer
❑ Farrow to Wean
Dry Rouitry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Pouets
l
Number of Structures:
❑ Other
❑ Other
I Li
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
yJ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: A0
Designed Freeboard (in): Z!Z I
Observed Freeboard (in): Zk
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 property addressed and/or managed
through a waste management or closure plan?
❑ Yes T No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
El Yes 0No El NA ❑NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes V1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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
t0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes �] No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Stodge into Bare Soil
❑ Outside of Acceptable Crop Window EJ Evidence of Wind Drifl ❑ Application Outsid of Area
12. Crop h'pe(s) d(Q � !�
13. Soil type(s) l*RF19CA,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 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 P,(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes A No
❑ NA
❑ NE
�'Comments (refer to question'-:#) Exploit; anyTYES'answers and/or{any recommendations or other comments.
Useliawingsrofffacility to tietter eaplain'setuations. (use additional pages as5necessaa.ry)�'� . t
?f �ZL}aie D .�F,Ef.�i9�e� ✓D O
O 5W44- 44G10�
ev iewr/Inspector Name Phone:r/Inspector
FReview,'
Signature: Date:
r
12/28704 Continued

1
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes '0 No ❑ NA [:IN E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes to No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
Z] No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
V1 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
)Z NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
r
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
12128104

Type of Visit )Z5 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O' Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: f Time:
0 Not Operational 0 Below Threshold
,z"Pernutted Certified [] Conditionally Certified © Registered Date Last Operated or Above Threshold: ....._.._..
Farm Name: ...... ✓.l4.``_.K�� 1.l.�.. .11.- -- County:.........
OwnerName: ........... . ...................................... ............... ........... . .......................... .. ........... Phone No: ... ........... ....._...... ..................... .......... ................. ......... ...
Mailing Address:
FacilityContact: .................................... Title: ... .............. ......................... Phone No: .............. ...............................
STE `
Onsite Representative: ....._.__..�.�....,.._........���._.........._ Integrator: .r.�.l,�,,,,,,,,,,,,,,,,,,
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' & 46 Longitude • ° 44
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �fNo
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 gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes gNo
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
Identifier: .......... /.......................................... ............. .................. _.... ............ -- - .................. ...... .._............ .........
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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 maintenancerirnprovement?
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? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop hype &9^08
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?
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 X,o
❑ Yes INO
❑ Yes �j No
ElYes No
❑ Yes No
❑ Yes /No
❑ Yes No
❑ Yes A No
ElYesZ.�
No
❑ Yes o
❑ Yes 16
No
Y(Yes [I No
//❑ Yes No
❑ Yes1111No
❑ Yes Iio
❑ Yes ll� No
❑ Yes UNo
Comments (refer to gneshQa #) EazplaQw;any YFS answers and/or airy -,,recommendations oraay other comments. w
e'ofbhto Beter exp... sitdateos. use ditto;Ueites as'necessra r]�? . ❑- e�l.d Copy-❑��
Final Notes
l
� aµ
•
S 3 Sow aC Tank, WItC, V66O P Xt--sPR.2G -;Alpte- ACCA
Ar,6tD_5 ( d-bk— 6�mD -
Reviewer/Inspector Name
ReviewerAnspector Signature:
Date:
12112103 Continued

Facility Number: 3 _ 3 Date of Inspection ! a
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes V0
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.
❑ Yes YNo
❑ 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 No
25. Did the facility fail to have a actively certified operator in charge?
o
❑ Y�OA
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/discharge, freeboard problems, over application)
❑ Yes [io
27. Did Reviewer/Impector fail to discuss review/inspection with on -site representative?
❑ Yes No
28. Does facility require a follow-up visit by same agency?
❑ YesyNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Ye ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes [:]No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 392 Date of Visit: 2/27/2002 Time: 16:Oo
F Not Operational Q Below Threshold
® Permitted ® Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: .........._ _.
Farm Name: Steve. Smith FarM .............................................................. .... County: AuAlitl------------------------------------ WiHQ.......
Owner Name: Stets - ------------._:_ h----------------------------- Phone No: 4�2G$=4ZQ4-------- -------- - --- ---
Mailing Address: J.42,.Wo.9djAlld..Chgrcal.RQAd ............................: ..... Alhc Uio.AC..................................... �� o..............
....................... ..................
,
Facility Contact: ........................Title:............................................... Phone No: ......................................
Onsite Representative: $Igy� th---------------------------------------- Integrator: RC0yEa!s-of
Certified Operator: S.fthr,&C...................... .. 'Smk t................. . Operator Certification Number: XQQ.7.8_..... .... ............................... .......................
Location of Farm:
Nest of Kornegay. On South side of SR 1514 approx. 0.2 mile West of SR 1501.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F 35 • 03 00 Longitude 77 • 57 36 u
_ Design Current :,.Design:Current .= Design_ Current
Swine Ca aci Po ulation Poultry.: .Capacity Population= „Cattle Capacity Population
❑ Wean to Feeder
® Feeder to Finish
2160
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ntNumberof La 000s ❑Subsurface Drains Prese❑Lagoon Area ❑Spray Field Area - -
_
Holding Ponds°I Solid Traps -1 ❑ 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)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
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: ............. I ............. ........................... .......................... ................. .--------- ----------------------.-.-............................
Freeboard (inches): 33

v�iwivl
- Faciaty Number: 31-392 Date of Inspection 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 Aunlication
10. Are there any buffers that need maintenance/improvement?
1 l . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Corn, Soybeans, Wheat Coastal Bermuda (Hay) Small Grain Overseed
e.unrrnueu
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable'acre determination? ❑ Yes []No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
N 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 #�=`Eaplaut_any YES answers and/or anymrecoinmendations or any o#her comments
Use drawmgs;of facility to better explain situafi�ns {use add�t�onal pages as necessary,] �'Fteld Copy ❑Final Notes
14. The wettable acres determination shows 90 degree arc patterns; this will most likely hydraulically overload the soil; need to consult
+
with the technical specialist and revise the wetted acres to an acceptable arc pattern for the soils on site. Also, modify waste plan and
record keeping accordingly to any modifications in the wettable acres.
19. Be sure to use a waste analysis dated within 60 days of the application events on the IRA-2's to calculate the nitrogen applied. Use
e correct beginning PAN allowance from the waste plan on the IRA-2's for wheat. The IRR-2 list oats as the receiving crop on the row
crop field, but wheat is planted in field as required by waste plan; be sure to label proper crop on IRR-2's. I highly recommend recording
e freeboard levels yourself instead of using the service person's readings which is the current practice.
Overall the facility and cro s are neatly kept.
rr
Reviewer/Inspector Name
p Stonewall Mathis
Reviewer/Inspector Signature: Date: s I Z_

O5103101 Continued
Facility Number: 31-392 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
p 1.
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 Iack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

Type of visit oCompliance Inspection O Operation Review O Lagoon Evaluation I
(Reason for Visit oRoutine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access I
Date of Visit: O 1/ D Time:
Facility Number 3 1 �
Q Not Operational 0 Below Threshold
0 Permitted 13 Certified © Condition-aBy Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ........... 54ed e, v-� : -i� Fe4. r e-, ............... . County: �'1...1.J. p lt.!:.'.................................... ..... ........
..rr...,,... .........
Owner Name...........J-FG1P e$:wL.r.'!..................................................................... Phone No:........................................................�
Facility Contact: ........... Title: . Phone No:
...................................................................................................................
MailingAddress: ............................................................................................. .
Onsite Representative:... Je._ �t�!.e'f� ........ Integrator: ,A9 rDur► r f ty � � ro 1:�4
........................................ . ..... ..
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * 4 &. Longitude ' 4 «
Design Current `
Svv�ne =. Capacity _Population
s ❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
y ❑ Farrow to Finish
❑ Gilts
❑ Boars
„_.
Design . .Current - Design ,-y Card
Poultry,Ci eci Po . dilation . _Cattle Ca aci - .-. Po ul
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Iota! SSLW--
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area ry
H#[i"g Ponds`! Solid Traps: ❑ No Liquid Waste Management System
Discharees & Stream Impacks
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier . ................. �.................
Freeboard (inches): -3Z
5100
❑ Yes XNo
❑ Yes ZNo
❑ Yes 0"No
h [a
❑ Yes J'No
❑ Yes XNo
❑ Yes 'ONO
❑ Yes XNo
Structure 6
Continued on buck

Facility Number: 3 j 2 Date of Inspection 14 t 0
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 Aaylication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Ber e",y4e, Pr,4 , S,�^Ir Co.—, L-tJI)e44 , <;ex4 Ay1S
13. Do the receiving crops differ with those designated in the Certified Animal Waste
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?
Reauired Records & Documents
❑ Yes �dNo
❑ Yes f TNo
❑ Yes ,fNo
❑ Yes j2fNo
❑ Yes ,EJ No
❑ Yes ONo
❑ Yes ,❑ No
Plan (CAWMP)? ❑ Yes . VrNo _
❑ Yes ONo
❑ Yes ONo
❑ Yes J�No
❑ Yes ,fNo
❑ Yes ONo
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes P'No
18. Does the facility fait to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ANo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ZNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 0 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes EfNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes El No
24. Does facility require a follow-up visit by same agency? ❑ Yes FJ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes j6 No
10 yiQlatiQnjs:er dgficiei�... vt re itOfdtkr-iAd this:v-isjt; - Yo0 will-recgiye 00 futfte
cori espo deuce: ahotif this visit.
T= _. _,. _
Comments {refer to•gnesgoin#}: _ Explarrt any.Yl,S answers and/or any reconupend>igarts ar.any other carntaen� �0. ::
Use dra�v�ngs of facihty to better eapiaua_situa00! (nse addiitional-pages as necessary) - _ fir.,.,
TI,e - ctC� dr y JcrojpS/ aid ewcords qre mci;h4gined '+�+ Ni excelick14
C
Reviewer/Inspector Name e t.•+ot {it 5
Reviewer/Inspector Signature: Date: / to / 5100

Fgffity Number: 31 — Z Date of Inspection !O 7) d
• Odor Lssues
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 VNo
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 'A 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 JZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5/00

livision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Y Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number [)ate of Visit: Time: Printed on: 7/21/2000
0 Not O erational 0 Below Threshold
Permitted 0 Cert�..i�ijed ©Conditionally Certified ©Registered Date Last Operated or )Above Threshold: ...................
Farm Name: S. .SM�!.fn..... county.p.. i�.......................................................
T ...
Owner Name: eye .!
.............. Phone IVo:.......................................................................................
Facility Contact: .......................................
MailingAddress: .................................................................
� 1
Onsite Representative:.,,tve '-+
Certified Operator:
Location of Farm:
Title:................................................................ Phone No:................................... ..........
Integrator:4? W►�..5.... ...614r+.g...................
........................................ Operator Certification Number:........................
..................
i
l�
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude C�• �° Longitude �• �` Des
Design Current
Swine Capacity POOUlatiOn
❑ Wean to Feeder
Feeder to Finish
2 J a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I d I[] Dairy
❑ Non -Layer I I I[] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagnnn Area 10 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 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-madc? ❑ Yes XNo
b. If discharge is observed. did it reach Water or the State'? (If yes, notify DWQ) El Yes No
c. If dischar�,e is observed. what is the estimated flow in gal/min? n
149
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes KNo
2. is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes jRrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes rK No
Suructure 1 Structure 2 Structurc 3 Structure 4 Structure 5 Structure 6
IdentiFier: ................................ ........................................
Freeboard (inches):
5100 Continued on back

FaeilityAiumber: Date of Inspection Printed on• 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes XNo
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes )4No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes JKNo
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? []Yes JgNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes P(No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [:]Yes P3No
12. Crop type 6e-ee tydet IC Gra;�t, re*'rt, LJhca , SeylSea�'►�
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?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as requilred 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?
14� A61hti6ds'oir di f ciebcies mere poked dtWing this: visit: - Y:oit will •-eeeive 4io futther - : -
correspondence. about. this visit .. ... ...
❑ Yes JKNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ;,No
❑ Yes ;ff No
❑ Yes NNo
• ❑ Yes gfNo
)gLyes ❑ No
❑ Yes No
❑ Yes JWNo
[-]Yes W No
❑ Yes -9No
❑ Yes ONo
❑ 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):
M. USG Fr�vrr�� d4,ec4 w qs }e grtq ly,r S S s/1 �jQ}�- 2-rer►�t-si
vs.� a>�ar e ed w �I 64 Ufa s 'W wr, 4Cap hcor4i001-

Facility Number: — Date of inspection OO 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 a�Jor 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 ZNo
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes
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 R 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 JRNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes V No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 9 No
Additional omments and/orDrawings:
5100
5100

Lagoon Dike Inspection Report
Name of Farm/Facility 5M1 -n-L. _ _ (-A 44 -3 — 3a 7-
Location of Farm/FaciIity
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:IV
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Naysaw, hi-e- z PsA _
Names of Inspectors
� 1
Freeboard, Feet
i—�
Top Width, Feet
l
Downstream Slope, xH:1 V 1
Yes r---No
Yes No
Yes No
Yes /No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes 1--- No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes -, No
9

Division of.Soil and Water Conservation - Operatron RevEew
-' C1;Division of Soil and Water`Conservation - Cce Inspection` „-
O°Division of Water Quality "= Compliance Inspection _
©;Other Agency - Operation Review,
IQ Routine - 0 Complaint 0 Follow -tip of DWQ inspection 0 Follow-up of DSIVC review 0 Other
Facility Number I}:ate of Inspection lV a`(
Time of inspection o t- 24 hr. (hh:mm)
10 Permitted © Certified Q Conditionally Certified 0 Registered 0 Not Operational I Date Last Operated:
Farm Name: v S .-........- ...................................... County: .1� ........................................
tL�G......... �� err.. �............... ............
Owner Name: �'(� . Sr•,• Phone No: EL�z 5t; _ �7ub
-�tLlsf�........................ .. .................................................. ........ --............-............-..........-.........-.........-
Facility Contact: .......................... Title: ---....-....- . Phone No:
i4tailing Address: .z....iatxi it> �-4� .vdr ....U.K. .... ..... ... ...��!!�{ � SM� t..i�!.L...................................... ..........................
Onsite Representative:.... ...we. InIA1.1 - . Integrator:.... ��?[�l%a.5............................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:........-.................................
Location of Farm:
............ .-..... side ......d..... A .... �.51 ... .... 0_3....iilrl b.S...... lJ SA ...... of...... �tg... I...��.�. .............................................................................
A,:
.............................................................................................. .................... .......... .............................. ,
Latitude Longitude �• �° ��°
Swine Capacity Population
❑ Wean to Feeder
[ZFeederto Finish
2,1 &0
14 p
❑ Farrow to Wean
❑ Farrow to Feeder'
❑ Farrow to Finish
❑ Gilts
LEA
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ____]❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity Zf Go
Total SSLW
Number of Lagoons L ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
I. is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance mail -made!
b- If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. li'dischartzc is observed. what is the estimated flow in aallmin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier:
Freeboard (inches): ............ZA................. ............. I...........
Structure 3 Structure 4 Structure 5
❑ Yes 1� No
❑ Yes R No
❑ Yes F�4hNo
NIA
❑ Yes
[P No
❑ Yes
[�ji J No
❑ Yes
E +No
❑ Yes Wo
Structure 6
1/6/99 Continued on hack

acillt -Number: 3� —�Z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or manabred 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 pact 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?
❑ Yes 04 No
❑ Yes fU No
® Yes ❑ No
❑ Yes [5 No
❑ Yes ® No
❑ Yes QPNo
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes P No
12. Crop typeY..!4!.-............!^�`�....!�Yn�Yh.......... l...........................................................................................
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?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a 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)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
0. NU.Vioiations:Or deficiencies .were doted Burin'g.ttiis:visftt.. You Niilfre�ceive nog further...:
cofrespoiidehee: about; this visit.: .:.:.:.:.:.:.:.:.:.:.:.:.:..:.:..:.: :.:.:.:.:.: .
.......................................................
❑ Yes [g No
[R Yes ❑ No
❑ Yes MNo
❑ Yes ® No
❑ Yes W No
❑ Yes 2PNo
JE? Yes ❑ No
❑ Yes [5PNo
❑ Yes [VNo
❑ Yes [�FNo
❑ Yes VNo
❑ Yes (ZfNo
Comments refer to question # . Explain any YES answers and/or an recom[nendations'or any ..other comments.=-. ry
Use drawhiks of facility to better -explain situations. (use additional pages:as necessary) a
7. F�ros;ar- pis o�! a i1pp+Y.,� Ws_l1{{ �1.odl ``''%e mn``n: r Q J � p`` ��.r ('+roblc►..s .� S �( / Oak I
�
� �1p,9�sr/J y, tV+( W� pre{t,YMi v�1�D^ f14u C.ow- +0� 1�Y��h ��0 L y -f /zf �_
- wu1 W '1tSkS [15S Cvv VA' Ot 44IJ C G. t �e �, each 1i•C�dd
Iq• � ccHvttk i kQ \,�vXb 4ie. vice..O tv c�cv � "k Mk"Nf,� NOIJ .-u%,
L, 9
l � SAI_' /
SV,-A a yc c�ci a t1 e,� G w e� it �•,� bps s a, , J lC�,e� w :— r� t-e c rl,rd s -
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: _ N f (a )g 1 11 /6/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
of DSWC review
Date of Inspection (,
Facility Number ( 392 Time of Inspection 3=L0 24 hr. (hh:mm)
Registered Certified [3 Applied for Permit E3Permitted JC1 Not Operational I Date Last Operated:
Farm Name: ..............SAsve
....... ^4-.....t Wt.t.................................................. County: .....
(a%pt��6..............................................................
Owner Name: ........ _.................,T.k: :....... ........5!hf.S.............................................. Phone No: .... 1....61...5AL-4.700......................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress ......... I.4. ....wCCwa.��C...... t:,.........0..................................... .......... tX��tC.tSmi-M....................................... ... 44511......
Onsite Representative:................1]kv......V.trS.Ihr.................................................... Integrator:........ hS......................................... ....................
Certified Operator:............................................................................................................... Operator Certification Number ..........................................
Location of Farm:
Latitude =• =, =" Longitude =• =' ="
❑ Wean to Feeder
( Feeder to Finish
21 U
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
General
1. Are there any buffers that need maintenance/improvement? - ❑ Yes Q(Vl No
2. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
it. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any pan of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any pan of the waste management system (other than lagoons/holding ponds) require
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes qj No
❑ Yes [0 No
o4A
❑ Yes P No
❑ Yes ® No
❑ Yes No
(Yes ❑ No
❑ Yes [ANo
❑ Yes 115 No

Facili4s, Number: 3 (— 2,
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (I.agoons.11olditg Ponds. Plush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure
Identifier: yy
Freeboard (ft) L'....................
Structure.'_ Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
[]Yes 5aNo
❑ Yes ® No
Structure 5 Structure 6
....................................................................
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
f
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify D«'Q) _
15. Crop type ........ JQ4t........... smail.... .axt1` ................._Oa its......5 ...................... ..................... ..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP?
25.'Were any additional problems noted which cause noncompliance of the Permit?
................................................
❑ Yes
No
❑ Yes
® No
® Yes
❑ No
❑ Yes
No
❑ Yes
® No
Th Yes
❑ No
❑ Yes
® No
[3 No.violations or de'riciencies.were"note'd during this.visit.- You.will receive no ftirtlier
correspondence a oitt"this'.visit.•
❑ Yes No
❑ Yes ® No
[P Yes No
❑ Yes LP
No
[P Yes ❑ No
❑ Yes 1P No
❑ Yes No
❑ Yes No
Cot lments (reUer'to" question #): "Explain any_YES answers and/or any recommendations or atny_�Other COInItEettts
Usedraw�ngs of facility"to better explain�situations. (usle additional pages as necessan ) iE
&nDi14— �: a� +fitStr �4vov1� �e t2Aoaltt!• r t B+J 1
42, i_rastnti— �a o%_
t b. So�ly)r c �tO kw r— t �� � oJas�c tram c. co1i
22— 0*,SVc So-+wt k- n,6j11'3 one. Ue801• 111bS�Ac N *- �ot— CerV%-%kOvl� Le- (GkO\,50J t,�
wvu - Say\reo�s -SkzvW �e C,44q;} � O Gvq rekvaAA-G . r #k �C 6 4� I •
�ifl►'L 5�111V Y�Q. a��1iCCi T� 1`���.G�.<.�ifr� � iM.4S� 1'QC�4.� 50\� �S`��
? 7/25/97
Reviewertinspector Name
a=
Reviewer/Inspector Signature: Date: F�-uot

�h DSWC Animal Feedlot Operation Review '
w
[� DWQ Animal Feedlot Operation Site Inspection
Routine O Com laint 0 Follow-u of IMins ection O Follow-up of DSWC review• Q�Othh�er
Date of Inspection
Facility Number 3
Time of Inspection 0 24 hr. (hh:mm)
Registered P9 Certified (3 Applied for Permit © Permitted 10 Not Operational I Date Last Operated: .........................
Farm lame ;!k ........ SK.c. 'G� County:..... RIM ................................
Owner Name: ........ 5tL�1 .....�.A-� . ................. ... Phone No:.� �1��. 0g'.�{ ��10...........................................
Facility Contact : ..............9' 4.�� ,..........6P. i.fT ................ Title: ......... 61Q.&LY..................................... Phone No: ... C 10)_5 a 747�..........
Mailing. Address: ..... i44........ �%.A.1Cn4 ......... a. .......�`�4 .P1. Mr ................................... ZM..........
rl ......................... E....
Onsite Representative:.........- S.tha. ( ..............R Lt wp.k 5.--------
............................. Into rator:........................ ......... ...........
<,........
Certified Operator;............................................................................................................... Operator Certification Number:.......e ri... D..........
Location of Farm:
....
..---.. A"5.- ....l��.t�tt�.....is.....0.... z--.In.�.i,�.s........ All ...... 501.1•. ....�?&.---._C1�.......................................................................................... .
Latitude
Longitude•
Design Current
Design Current
Design ., Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
I
ID Layer
Dairy
der toFini Feesh
x
❑ Non -Layer
FEI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity :
f (Q D
❑ Gilts
-
Total SSLW
❑ Boars
Number of Lagoons / Holding Ponds, ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement'? ❑ Yes (A No
2. Is any discharge observed from any part of the operation? ❑ Yes [Z No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-tnade?
b. If discharge is observed, did it reach Surface Water? (It yes, notify DWQ)
c. If dischar+oe is observed, what is the estimated Flow in-alhnin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ® No
❑ Yes N No
tA
❑ Yes EANo
❑ Yes ]A No
❑ Yes PNo
❑ Yes 0 No
❑ Yes [A No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes a$ No
Continued on back

Facility Number: 31 — 3
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons.Holdine Pouds,Flush _Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure i Structure 2 Structure 3 Structure 4
❑ Yes 5�No
❑ Yes P No
Structure 5 Structure 6
Identifier: ............................... .
Freeboard(ft):...........3............................................. ....
10. Is seepage observed from any of the structures?
❑ Yes
W No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance/improvement?
P Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, orttruynoff entering waters'of the State, notify DWQ)
15. Crop type--.....Coo.S�l.....UN..1A..................................... iE [.................................._st'?: al....5[A..................sayA1CWn�........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
P.No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
ER No
18. Does the receiving crop need improvement?
❑ Yes
IRNo
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22. Does record keeping need improvement? Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ® No
No.violations or deficiencies. were noted during this:visit. You.will receive'no further,
correspondence about this.visit:
Conunents'(refer to question #): Eiplain any YES answers ftd/or any recommendations: or. any other comments:
Use drawings of facility to better explain situations. (use additional pages as:necessary}
'.
V, LG9ao� walls s1.ov� �� ot�cri • f' ` '''
22 Vi ei3 Yvm1�¢rs ir\ Wos �[71��1l+an Qiar. s�tov�d SAe
t-ecorr�s S�ov�r� 6-7 by , , (\um er &nj C-VeO nuw%bW. U��W soi ( 44, (,Y�,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: q

•
•
Site Requires I=ediate Attention:
Facility No. :r! ~ 3 9 Z
DIVISION OF ENVIRONMENTAL MANAGEm ENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -
Z'A , 1995
Time: ':_G a
Farm Name/Owner:
Mailing Address:
County: DUB
Integrator. Ur(1)0
On Site Representative: ,—
Physical Address/]
Sm A r-:;;r,
Type of Operation: Swine t'_� Poultry
Cattle
k) G Z So S
Phone: 2,93 — 5(o00
Phone:919- s&$ -4100
Design Capacity: zi 0 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 35 03 •8�7' Longitude: ' 35•$ 3 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot _ 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes r No Actual Freeboard, Ft. �� Inches
Was any seepage observed from the laQoon(s)? Yes o No Was any erosion observed? Yes No
Is adequate land available for spray?Ye es r No Is the cover crop adequate? or No
Crop(s) being utilized: 2 fO eWm
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments:
L L ew
Inspector Name
cc: Facility Assessment Unit
AL
Signature
Us;! Attachments if Needed.
11